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Contribution of clinical severity and geriatric risk factors in predicting short-term mortality of older hospitalized pneumonia patients: the Pneumonia in Italian Acute Care for Elderly units (PIACE) study

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Abstract

Background

Clinical severity of pneumonia in older persons increases the risk for short-term mortality. Comprehensive geriatric assessment (CGA) may provide further insight in prognostic stratification.

Aims

To investigate whether CGA may improve prognostic stratification among older patients with pneumonia admitted to hospital.

Methods

Our series consisted of 318 consecutive patients hospitalized for pneumonia in a multicenter observational study. Disease severity was assessed by Sequential Organ Failure Assessment (SOFA) and Pneumonia Severity Index (PSI). CGA included the occurrence of delirium, Basic Activities of Daily Living (BADL) disability, cognitive impairment at Short Portable Mental Status Questionnaire (SPMSQ) and overall comorbidity assessed by Cumulative Illness Rating Scale (CIRS). The outcomes were in-hospital and post-discharge 3 month mortality. Statistical analysis was carried out by Cox regression, area under receiver operating curve (AUC) and net reclassification index (NRI).

Results

Overall, 53 patients died during hospitalization and 52 after discharge. Delirium, SOFA score and admission BADL disability were significant predictors of in-hospital mortality. SOFA score, CIRS, previous long-term oxygen therapy and discharge BADL dependency significantly predicted post-discharge mortality. The accuracy of SOFA in predicting in-hospital and post-discharge mortality was fair (AUC = 0.685, 95% CI = 0.610–0.761 and AUC = 0.663, 95% CI = 0.593–0.734, respectively). BADL dependency and delirium improved predictive accuracy for in-hospital mortality (ΔAUC = 0.144, 95% CI = 0.062–0.227, p < 0.001), while pre-admission oxygen therapy, CIRS and BADL dependency improved predictivity for 3 month mortality (ΔAUC = 0.177, 95% CI = 0.102–0.252, p < 0.001).

Discussion

Among older pneumonia patients, prognostic stratification obtained by clinical severity indexes is significantly improved by CGA risk factors.

Conclusions

CGA provides important information for prognostic stratification and clinical management of older pneumonia patients.

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Acknowledgements

PIACE Study Group Collaborators: Filippo Luca Fimognari, Massimo Rizzo, Olga Cuccurullo, Giovanna Cristiano, Valentina Bambara, Andrea Arone, Andrea Corsonello, Bruno Mazzei, Giorgio Maiuri, Silvio Vena, Giovanni Ruotolo, Alfonso Merante, Giuliano Ceschia, Gabriele Toigo, Francesco Di Grezia, Immacolata Alviggi, Maurizio Luchetti, Rosa Maria Mereu, Olga Catte, Vittoria Tibaldi, Alberto Ferrari, Luca Carpi, Maria Lia Lunardelli, Pasquale Vizzo, Emilio Martini, Alfredo Zanatta, Giorgio Gasperini, Chiara Pavan, Francesco De Filippi, Michela Passamonte, Anna Nardelli, Sandra Visioli, Fabrizio Franchi, Marco Masina, Antonio Cherubini, Antonia Scrimieri, Demetrio Postacchini, Roberto Brunelli, Gianfranco Conati, Eleonora Ruberto, Alberto Pilotto, Mario Lo Storto, Paolo Chioatto, Maria Rita Gulino, Michele Pagano, Giovanna Crupi, Biagio Ierardi, Bruno Provenzano.

Funding

PIACE study was performed without any funding.

Author information

Authors and Affiliations

  1. Unit of Geriatrics, Department of Internal Medicine, Annunziata-Mariano Santo-S. Barbara Hospital, 87100, Cosenza, Italy

    Filippo Luca Fimognari, Massimo Rizzo, Valentina Bambara, Andrea Arone & Olga Cuccurullo

  2. Research Hospital of Cosenza, Italian National Research Center on Aging (INRCA), Cosenza, Italy

    Andrea Corsonello

  3. Research Hospital and Scientific Direction, Italian National Research Center on Aging (INRCA), Ancona, Italy

    Paolo Fabbietti

  4. Unit of Geriatrics, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genova, Italy

    Alberto Pilotto

  5. Unit of Geriatrics, S. Maria Nuova Hospital, Reggio Emilia, Italy

    Alberto Ferrari

Authors
  1. Filippo Luca Fimognari
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  2. Andrea Corsonello
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  6. Andrea Arone
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  7. Olga Cuccurullo
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Consortia

On Behalf of the PIACE Study Group

  • Filippo Luca Fimognari
  • , Massimo Rizzo
  • , Olga Cuccurullo
  • , Giovanna Cristiano
  • , Valentina Bambara
  • , Andrea Arone
  • , Andrea Corsonello
  • , Bruno Mazzei
  • , Giorgio Maiuri
  • , Silvio Vena
  • , Giovanni Ruotolo
  • , Alfonso Merante
  • , Giuliano Ceschia
  • , Gabriele Toigo
  • , Francesco Di Grezia
  • , Immacolata Alviggi
  • , Maurizio Luchetti
  • , Rosa Maria Mereu
  • , Olga Catte
  • , Vittoria Tibaldi
  • , Alberto Ferrari
  • , Luca Carpi
  • , Maria Lia Lunardelli
  • , Pasquale Vizzo
  • , Emilio Martini
  • , Alfredo Zanatta
  • , Giorgio Gasperini
  • , Chiara Pavan
  • , Francesco De Filippi
  • , Michela Passamonte
  • , Anna Nardelli
  • , Sandra Visioli
  • , Fabrizio Franchi
  • , Marco Masina
  • , Antonio Cherubini
  • , Antonia Scrimieri
  • , Demetrio Postacchini
  • , Roberto Brunelli
  • , Gianfranco Conati
  • , Eleonora Ruberto
  • , Alberto Pilotto
  • , Mario Lo Storto
  • , Paolo Chioatto
  • , Maria Rita Gulino
  • , Michele Pagano
  • , Giovanna Crupi
  • , Biagio Ierardi
  •  & Bruno Provenzano

Corresponding author

Correspondence to Filippo Luca Fimognari.

Ethics declarations

Conflict of interest

The authors declare they have no conflict of interest regarding the study.

Ethical approval

The study protocol of PIACE study was examined and approved by the Institutional Ethical Committee of the coordinating center (Unit of Geriatrics, Annunziata Hospital, Azienda Ospedaliera di Cosenza, Cosenza, Italy). The approved protocol was transmitted to all participating centers; the Institutional Ethical Committee of each center could ask for clarifications of the protocol.

Statement of human and animal rights

This is an observational study conducted in humans. All patients or their surrogates provided written informed consent.

Informed consent

All enrolled patients or their surrogates provided written informed consent.

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The PIACE study group collaborators are listed in the acknowledgments section.

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Fimognari, F.L., Corsonello, A., Rizzo, M. et al. Contribution of clinical severity and geriatric risk factors in predicting short-term mortality of older hospitalized pneumonia patients: the Pneumonia in Italian Acute Care for Elderly units (PIACE) study. Aging Clin Exp Res 34, 1419–1427 (2022). https://doi.org/10.1007/s40520-021-02063-y

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  • DOI: https://doi.org/10.1007/s40520-021-02063-y

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