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      Risk for prolonged hospitalization and mortality in aged community acquired pneumonia patients: a retrospective study in Japan

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          Abstract

          The present study aimed to reveal; i) risk for prolonged hospitalization and mortality in aged community acquired pneumonia patients, and ii) whether swallowing ability was related to re-hospitalization. The present retrospective study included 92 patients older than 75 years hospitalized with community acquired pneumonia in Takagi Hospital between April 2017 and March 2018. The patients were classified into 3 groups; discharged within 17 days (group I): hospitalized more than 18 days (group II): died during the hospitalization (group III). Swallowing ability was evaluated if available. Univariate analysis indicated males and body mass index (BMI) in group I ( n = 24) were higher than group II ( n = 46). Group III ( n = 22) had low serum albumin, low BMI, and severe disease progression compared with group I. Multivariate analysis demonstrated that group II BMI was lower than group I [odds ratio (OR) = 1.18, p = 0.042]. Group III had lower serum albumin level compared with group I (OR = 81.01, p = 0.025). Diabetes mellitus ( p = 0.009), but not swallowing disability, was risk for readmission. Malnutrition represented by low albumin enhanced mortality rate in the pneumonia patients, and low BMI and diabetes mellitus might increase the pneumonia risk.

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          Most cited references35

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          Toxicity and response criteria of the Eastern Cooperative Oncology Group.

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            Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study.

            W S Lim (2003)
            In the assessment of severity in community acquired pneumonia (CAP), the modified British Thoracic Society (mBTS) rule identifies patients with severe pneumonia but not patients who might be suitable for home management. A multicentre study was conducted to derive and validate a practical severity assessment model for stratifying adults hospitalised with CAP into different management groups. Data from three prospective studies of CAP conducted in the UK, New Zealand, and the Netherlands were combined. A derivation cohort comprising 80% of the data was used to develop the model. Prognostic variables were identified using multiple logistic regression with 30 day mortality as the outcome measure. The final model was tested against the validation cohort. 1068 patients were studied (mean age 64 years, 51.5% male, 30 day mortality 9%). Age >/=65 years (OR 3.5, 95% CI 1.6 to 8.0) and albumin 7 mmol/l, Respiratory rate >/=30/min, low systolic( /=65 years (CURB-65 score) based on information available at initial hospital assessment, enabled patients to be stratified according to increasing risk of mortality: score 0, 0.7%; score 1, 3.2%; score 2, 3%; score 3, 17%; score 4, 41.5% and score 5, 57%. The validation cohort confirmed a similar pattern. A simple six point score based on confusion, urea, respiratory rate, blood pressure, and age can be used to stratify patients with CAP into different management groups.
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              Diabetes, Glycemic Control, and Risk of Hospitalization With Pneumonia

              OBJECTIVE—To examine whether diabetes is a risk factor for hospitalization with pneumonia and to assess the impact of A1C level on such risk. RESEARCH DESIGN AND METHODS—In this population-based, case-control study we identified patients with a first-time pneumonia-related hospitalization between 1997 and 2005, using health care databases in northern Denmark. For each case, 10 sex- and age-matched population control subjects were selected from Denmark's Civil Registration System. We used conditional logistic regression to compute relative risk (RR) for pneumonia-related hospitalization among subjects with and without diabetes, controlling for potential confounding factors. RESULTS—The study included 34,239 patients with a pneumonia-related hospitalization and 342,390 population control subjects. The adjusted RR for pneumonia-related hospitalization among subjects with diabetes was 1.26 (95% CI 1.21–1.31) compared with nondiabetic individuals. The adjusted RR was 4.43 (3.40–5.77) for subjects with type 1 diabetes and 1.23 (1.19–1.28) for subjects with type 2 diabetes. Diabetes duration ≥10 years increased the risk of a pneumonia-related hospitalization (1.37 [1.28–1.47]). Compared with subjects without diabetes, the adjusted RR was 1.22 (1.14–1.30) for diabetic subjects whose A1C level was <7% and 1.60 (1.44–1.76) for diabetic subjects whose A1C level was ≥9%. CONCLUSIONS—Type 1 and type 2 diabetes are risk factors for a pneumonia-related hospitalization. Poor long-term glycemic control among patients with diabetes clearly increases the risk of hospitalization with pneumonia.
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                Author and article information

                Journal
                J Clin Biochem Nutr
                J Clin Biochem Nutr
                JCBN
                Journal of Clinical Biochemistry and Nutrition
                the Society for Free Radical Research Japan (Kyoto, Japan )
                0912-0009
                1880-5086
                November 2020
                31 July 2020
                : 67
                : 3
                : 302-306
                Affiliations
                [1 ]International University of Health and Welfare Graduate School of Medicine, 137-1 Enokizu, Ookawa-city, Fukuoka 831-8501, Japan
                [2 ]Divisions of Respirology, Kouhou-kai Takagi Hospital, 141-11 Sakami, Ookawa-city, Fukuoka 831-0016, Japan
                [3 ]Clinical Research Center, Saga University Hospital, 5-1-1 Nabeshima, Saga 849-8501, Japan
                [4 ]Otorhinolarygology, Kouhou-kai Takagi Hospital, 141-11 Sakami, Ookawa-city, Fukuoka 831-0016, Japan
                Author notes
                *To whom correspondence should be addressed. E-mail: matsuo@ 123456kouhoukai.org
                Article
                DN/JST.JSTAGE/jcbn/20-85 20-85
                10.3164/jcbn.20-85
                7705084
                33293772
                761cd94a-e377-47a6-b2c6-0270ac375aa2
                Copyright © 2020 JCBN

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License ( http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 25 May 2020
                : 29 May 2020
                Categories
                Original Article

                Biochemistry
                serum albumin,body mass index,curb-65,comorbidity,swallowing ability
                Biochemistry
                serum albumin, body mass index, curb-65, comorbidity, swallowing ability

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