The prognosis was poorer in patients with basic dementia or Alzheimer’s disease as well as chronic obstructive pulmonary disease or asthma.
A new study found a correlation between poor nutritional status-related index and inflammation index, further showing that poor nutritional status can predict a high risk of pneumonia in older adults.
The results were published in Frontiers in Medicine.
The authors of the study found that older age and comorbidities are risk factors for both the occurrence and poor prognosis of pneumonia, indicating that comorbidities in elderly patients (65 years and over) with pneumonia should be well managed.
Two main types of pneumonia are hospital-acquired pneumonia (HAP) and community-acquired pneumonia (CAP). The study divided 669 patients into these groups of 517 and 152 participants, respectively.
Among the patients, 72.65% were men and their mean age (SD) was 84.87 (8.49) years. Her mean age-adjusted Charlson comorbidity index (aCCI) was 6.34 (1.97). In addition, 42.60% received anti-infection treatment for 7 days or less, 28.91% for 8 to 14 days, 13.14% for 15 to 21 days, 5.81% for 22 days or more, and 9.54% to to death.
The study found that the infection result correlates negatively with age in all patients (P = .013) and that the albumin level correlates negatively with the infection prognosis in all patients (P = .03). The albumin level was also negatively correlated with neutrophil count and C-reactive protein (CRP) (P = 0.008 and P <0.001, respectively). ACCI was positively correlated with CRP (P = 0.003) and the prognosis was negatively associated with age and albumin levels.
The prognosis was worse in patients with basic dementia or Alzheimer’s disease and chronic obstructive pulmonary disease (COPD) or asthma.
“In the HAP group, we selected myocardial infarction, albumin, chlorine and chronic obstructive pulmonary disease as risk factors that together make an AUC. achieved [area under the curve] of 0.6219, ”said the authors. “In the CAP group, we used calcium, chlorine, lymphocyte count and myocardial infarction to calculate the total score and achieve an AUC of 0.6066.”
The study found no significant difference in gender, age, aCCI, or most underlying diseases between the HAP and CAP groups (P> 0.05). The authors also found that nutritional status differs between regions.
“It was found that the nutritional status of both CAP and HAP patients was a risk factor for the occurrence and prognosis of pneumonia compared to other underlying diseases,” the authors say. “Common underlying diseases affect diet, including diabetes, COPD, cerebrovascular disease, hemiplegia, dementia, stomach ulcers, moderate chronic kidney disease, liver disease.”
Myocardial infarction (P = .031) and COPD (P = .024) were also associated with a significantly higher risk of negative outcome.
Cerebral infarction, cerebral hemorrhage, and other cerebrovascular diseases were also listed as underlying diseases that predispose older patients to pneumonia in addition to left-sided swallowing disorders. An esophageal tracheal fistula can also cause aspiration pneumonia – the most common type of pneumonia in the elderly.
“In this study, the course of pneumonia in patients with COPD, dementia, cerebrovascular diseases and hemiplegia was significantly prolonged,” the authors say. “Similarly, the tumor has also been identified as a risk factor for pneumonia in elderly patients. This may be due to a decrease in immunity after taking hormones, immunosuppressants, or chemotherapy. “
According to the authors, the Mini Nutritional Assessment Table (MNA) and the Short Form MNA are fast and reliable methods for assessing the nutritional status of patients aged 65 and over.
“Nutritional screening and targeted nutritional education should be done to reduce the incidence of nutritional disorder and pneumonia in the elderly,” they said.
reference
Chen B, Liu W, Chen Y, et al. Effects of poor nutritional status and comorbidities on the incidence and progression of pneumonia in older adults. Front Med. Published online October 12, 2021. doi: 10.3389 / fmed.2021.719530
