A Composite of Functional Status and Pneumonia Severity Index Improves the Prediction of Pneumonia Mortality in Older Patients

  • Francisco Sanz
  • María Morales-Suárez-Varela
  • Estrella Fernández
  • Luis Force
  • María José Pérez-Lozano
  • Vicente Martín
  • Mikel Egurrola
  • Jesús Castilla
  • Jenaro Astray
  • Diana Toledo
  • Ángela Domínguez
  • Project PI12/02079 Working Group
Original Research

Abstract

Background

The baseline health status may be a determinant of interest in the evolution of pneumonia.

Objective

Our objective was to assess the predictive ability of community-acquired pneumonia (CAP) mortality by combining the Barthel Index (BI) and Pneumonia Severity Index (PSI) in patients aged ≥ 65 years.

Design, patients and main measures

In this prospective, observational, multicenter analysis of comorbidities, the clinical data, additional examinations and severity of CAP were measured by the PSI and functional status by the BI. Two multivariable models were generated: Model 1 including the PSI and BI and model 2 with PSI plus BI stratified categorically.

Key results

The total population was 1919 patients, of whom 61% had severe pneumonia (PSI IV–V) and 40.4% had some degree of dependence (BI ≤ 90 points). Mortality in the PSI V–IV group was 12.5%. Some degree of dependence was associated with increased mortality in both the mild (7.2% vs. 3.2%; p = 0.016) and severe (14% vs. 3.3%; p < 0.001) pneumonia groups. The combination of PSI IV–V and BI ≤ 90 was the greatest risk factor for mortality (aOR 4.17; 95% CI 2.48 to 7.02) in our series.

Conclusions

The use of a bimodal model to assess CAP mortality (PSI + BI) provides more accurate prognostic information than the use of each index separately.

KEY WORDS

functional status community-acquired pneumonia severity assessment 

Notes

Acknowledgements

The members of the Project PI12/02079 Working Group are: Andalusia: J.M. Mayoral (Servicio de Vigilancia de Andalucía), J. Díaz-Borrego (Servicio Andaluz de Salud), A. Morillo (Hospital Universitario Virgen del Rocío), M.J. Pérez-Lozano (Hospital Universitario Virgen de Valme), J. Gutiérrez (Hospital Universitario Puerta del Mar), M. Pérez-Ruiz, M.A. Fernández-Sierra (Complejo Hospitalario Universitario de Granada). Castile and Leon: S. Tamames (Dir. General de Salud Pública, Investigación, Desarrollo e Innovación, Junta de Castilla y León), S. Rojo-Rello (Hospital Clínico Universitario de Valladolid), R. Ortiz de Lejarazu (Universidad de Valladolid), M.I. Fernández-Natal (Complejo Asistencial Universitario de León), T. Fernández-Villa (GIIGAS-Grupo de Investigación en Interacción Gen-Ambiente y Salud, Universidad de León), A. Pueyo (Hospital Universitario de Burgos), V. Martin (Universidad de León; CIBERESP). Catalonia: A. Vilella (Hospital Clínic), M. Campins, A. Antón (Hospital Universitari Vall d’Hebron; Universitat Autónoma de Barcelona), G. Navarro (Corporació Sanitària i Universitaria Parc Taulí), M. Riera (Hospital Universitari MútuaTerrassa), E. Espejo (Hospital de Terrassa), M.D. Mas, R. Pérez (ALTHAIA, Xarxa Hospitalaria de Manresa), J.A. Cayla, C. Rius (Agència de Salut Pública de Barcelona; CIBERESP), P. Godoy (Agència de Salut Pública de Catalunya; Institut de Recerca Biomèdica de Lleida, Universitat de Lleida; CIBERESP), N. Torner (Agència de Salut Pública de Catalunya; Universitat de Barcelona; CIBERESP), C. Izquierdo, R. Torra (Agència de Salut Pública de Catalunya), L. Force (Hospital de Mataró), A. Domínguez, N. Soldevila, D. Toledo, I. Crespo (Universitat de Barcelona; CIBERESP). Madrid: J. Astray, M.F. Domínguez-Berjon, M.A. Gutiérrez, S. Jiménez, E. Gil, F. Martín, R.Génova-Maleras (Consejería de Sanidad), M.C. Prados, F. Enzzine de Blas, M.A. Salvador, J. Rodríguez, M. Romero (Hospital Universitario la Paz), J.C Galán, E. Navas, L. Rodríguez-Rojas (Hospital Ramón y Cajal), C.J. Álvarez, E. Banderas, S. Fernández (Hospital Universitario 12 de Octubre). Navarra: J. Chamorro (Complejo Hospitalario de Navarra), I. Casado, J. Díaz (Instituto de Salud Pública, Instituto de Investigación Sanitaria de Navarra; CIBERESP), J. Castilla (Instituto de Salud Pública, Instituto de Investigación Sanitaria de Navarra; CIBERESP). The Basque Country: M. Egurrola, M.J. López de Goicoechea (Hospital de Galdakao). Valencia Community: M. Morales-Suárez-Varela (Universidad de Valencia; CIBERESP), F. Sanz (Consorci Hospital General Universitari de Valencia).

Prior presentations

This work has not been presented in any meeting or conference.

Author Contributions

Substantial contributions to conception or design of the work: FS, MM, EF, LF, MJP, VM, ME, JC, JA, DT, AD. Substantial contributions to the acquisition, analysis, and interpretation of data for the work: FS and EF. Drafting of the work or revising it critically for important intellectual content: FS, MM, EF, LF, MJP, VM, ME, JC, JA, DT, AD. Final approval of the version to be published: FS, MM, EF, LF, MJP, VM, ME, JC, JA, DT, AD. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: FS, MM, EF, LF, MJP, VM, ME, JC, JA, DT, AD

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.

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Copyright information

© Society of General Internal Medicine 2017

Authors and Affiliations

  • Francisco Sanz
    • 1
  • María Morales-Suárez-Varela
    • 2
    • 3
  • Estrella Fernández
    • 1
  • Luis Force
    • 4
  • María José Pérez-Lozano
    • 5
  • Vicente Martín
    • 6
  • Mikel Egurrola
    • 7
  • Jesús Castilla
    • 3
    • 8
  • Jenaro Astray
    • 9
  • Diana Toledo
    • 3
    • 10
  • Ángela Domínguez
    • 3
    • 10
  • Project PI12/02079 Working Group
  1. 1.Consorci Hospital General Universitari de ValènciaValènciaSpain
  2. 2.Universitat de ValènciaValènciaSpain
  3. 3.CIBER Epidemiología y Salud Pública (CIBERESP)MadridSpain
  4. 4.Hospital de MataróMataróSpain
  5. 5.Hospital Universitario Virgen de ValmeSevillaSpain
  6. 6.Universidad de LeónLeónSpain
  7. 7.Hospital de GaldakaoUsansoloSpain
  8. 8.Instituto de Salud Pública de NavarraIdiSNAPamplonaSpain
  9. 9.Consejería de SanidadMadridSpain
  10. 10.Departament de Salut PúblicaUniversitat de BarcelonaBarcelonaSpain

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