Prognostic significance of malnutrition for long-term mortality in community-acquired pneumonia: a propensity score matched analysis
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Background/Aims: The impact of malnutrition on the outcome of hospitalized adults with community-acquired pneumonia (CAP) has not been fully investigated. This study evaluated the prevalence and prognostic significance of malnutrition in a Korean population with CAP. Methods: In total, 198 patients with CAP from November 2014 to September 2015 were analyzed retrospectively. We assessed the prevalence of malnutrition and the risk factors for 2-year mortality. Furthermore, we divided the patients into two groups: elderly (age ≥ 65 years, n = 131) and non-elderly (age < 65 years, n = 67). Subgroup analyses were performed in the elderly group through propensity score matching. Results: The prevalence of malnutrition was 39.4%, and the proportion of patients with malnutrition was significantly higher (53.4% vs. 11.9%, p < 0.001) in the elderly group than in the non-elderly group. In-hospital mortality, 1-year mortality, and 2-year mortality rates were 4.5%, 19.2%, and 26.8%, respectively. Multivariate Cox regression analyses revealed that malnutrition (odds ratio [OR], 2.52; 95% confidence interval [CI], 1.39 to 4.60; p = 0.002) and the Charlson comorbidity index score (OR, 1.30; 95% CI, 1.17 to 1.45; p < 0.001) were associated with 2-year mortality. Conclusions: Malnutrition was common and associated with a poor long-term outcome in patients with CAP, particularly the elderly. A routine nutritional assessment at admission is mandatory as a first step for appropriate nutritional therapy.
Abstract
Background/Aims: The impact of malnutrition on the outcome of hospitalized adults with community-acquired pneumonia (CAP) has not been fully investigated. This study evaluated the prevalence and prognostic significance of malnutrition in a Korean population with CAP. Methods: In total, 198 patients with CAP from November 2014 to September 2015 were analyzed retrospectively. We assessed the prevalence of malnutrition and the risk factors for 2-year mortality. Furthermore, we divided the patients into two groups: elderly (age ≥ 65 years, n = 131) and non-elderly (age < 65 years, n = 67). Subgroup analyses were performed in the elderly group through propensity score matching. Results: The prevalence of malnutrition was 39.4%, and the proportion of patients with malnutrition was significantly higher (53.4% vs. 11.9%, p < 0.001) in the elderly group than in the non-elderly group. In-hospital mortality, 1-year mortality, and 2-year mortality rates were 4.5%, 19.2%, and 26.8%, respectively. Multivariate Cox regression analyses revealed that malnutrition (odds ratio [OR], 2.52; 95% confidence interval [CI], 1.39 to 4.60; p = 0.002) and the Charlson comorbidity index score (OR, 1.30; 95% CI, 1.17 to 1.45; p < 0.001) were associated with 2-year mortality. Conclusions: Malnutrition was common and associated with a poor long-term outcome in patients with CAP, particularly the elderly. A routine nutritional assessment at admission is mandatory as a first step for appropriate nutritional therapy.
참고문헌 (26)
- Almirall J, "Risk factors for community-acquired pneumonia in adults : a systematic review of observational studies", Respiration, 94, pp.299~311 (2017)
- Loeb M, "The effect of malnutrition on risk and outcome of community-acquired pneumonia", Respir Care Clin N Am, 11, pp.99~108 (2005)
- Tokgoz Akyil F, "Prognosis of hospitalized patients with community-acquired pneumonia", Pulmonology, 24, pp.164~169 (2018)
- Rodriguez-Pecci MS, "Nutritional status and mortality in community acquired pneumonia", Medicina(B Aires), 70, pp.120~126 (2010)
- Barker LA, "Hospital malnutrition : prevalence, identification and impact on patients and the healthcare system", Int J Environ Res Public Health, 8, pp.514~527 (2011)
- Jensen GL, "Inflammation as the key interface of the medical and nutrition universes : a provocative examination of the future of clinical nutrition and medicine", JPEN J Parenter Enteral Nutr, 30, pp.453~463 (2006)
- Evans C, "Malnutrition in the elderly : a multifactorial fail-ure to thrive", Perm J, 9, pp.38~41 (2005)
- "2017 Statistics on the aged" (2017)[URL]
- 이정연, "Disease burden of pneumonia in Korean adults aged over 50 years stratified by age and underlying diseases", The Korean Journal of Internal Medicine, 29(6), pp.764~773 (2014), 대한내과학회[DOI]
- 유광하, "Economic Burden and Epidemiology of Pneumonia in Korean Adults Aged over 50 Years", Journal of Korean Medical Science, 28(6), pp.888~895 (2013), 대한의학회
- 김혜인, "Mortality of Community-Acquired Pneumonia in Korea: Assessed with the Pneumonia Severity Index and the CURB-65 Score", Journal of Korean Medical Science, 28(9), pp.1276~1282 (2013), 대한의학회
- 장현하, "노인성 폐렴", 대한내과학회지, 79(4), pp.346~355 (2010), 대한내과학회
- White JV, "Consensus statement:Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition. Characteristics recommended for the identification and documentation of adult malnutrition (undernutrition)", EN J Parenter Enteral Nutr, 36, pp.275~283 (2012)
- White JV, "Consensus statement of the Academy of Nutrition and Dietetics", American Society for Parenteral and Enteral Nutrition : characteristics recommended for the identification and documentation of adult malnutrition(undernutrition), 2012, pp.112, 730~738
- Ho DE, "Matching as nonparametric preprocessing for reducing model dependence in parametric causal inference", Polit Anal, 15, pp.199~236 (2007)
- Ho DE, "MatchIt : nonparametric preprocessing for parametric causal inference", J Stat Softw, 42 (2011)
- Diamond A, "Genetic matching for estimating causal effects : a general multivariate matching method for achieving balance in observational studies", Rev Econ Stat, 95, pp.932~945 (2013)
- Stupka JE, "Community-acquired pneumonia in elderly patients", Aging health, 5, pp.763~774 (2009)
- Zhang ZX, "Prognostic factors for mortality due to pneumonia among adults from different age groups in Singapore and mortality predictions based on PSI and CURB-65", Singapore Med J, 59, pp.190~198 (2018)
- Kopelman P, "Nutrition and patients: a doctor's responsibility", Clin Med (Lond), 2, pp.391~394 (2002)
- Muhlethaler R, "The prognostic significance of protein-energy malnutrition in geriatric patients", Age Ageing, 24, pp.193~197 (1995)
- Ma HM, "Predictors of in-hospital mortality of older patients admitted for community-acquired pneumonia", Age Ageing, 40, pp.736~741 (2011)
- Riquelme OR, "Community-acquired pneumonia in the elderly : clinical and nutritional aspects", Rev Med Chil, 136, pp.587~593 (2008)
- Vecchiarino P, "Short-term outcomes and their predictors for patients hospitalized with community-acquired pneumonia", Heart Lung, 33, pp.301~307 (2004)
- Harris D, "Malnutrition screening in the elderly population", J R Soc Med, 98, pp.411~414 (2005)
- Jo HJ, "The impact of multidisciplinary nutritional team involvement on nutritional care and outcomes in a medical intensive care unit", Eur J Clin Nutr, 71, pp.1360~1362 (2017)