Methods: We conducted a retrospective cohort study of all inpatients 50 years and older with culture-confirmed PD from a large Midwest academic hospital between 1/1/2002 and 11/30/2012. Demographic, risk factor, and outcomes data were collected through medical informatics queries and manual chart review. Univariate analyses were conducted to compare variables between age groups, comorbidity status and immune status. Multivariate analysis was performed to identify variables associated with 30 day mortality.
Results: We identified 664 inpatients with PD: 285 (43%) had invasive PD (IPD), 281 (42%) were age ≥65, 351 (53%) had at least one comorbidity, and 290 (44%) were immunocompromised. Compared to the 50-64 age group, patients in the ≥65 age group had a higher risk of mortality (22% vs. 14%, p<0.01), ICU requirement (58% vs 50%, p=0.04), and not being discharged to home (47% vs 33%, p<0.01). Presence of any medical comorbidity was associated with lower IPD risk (36% vs 51%, p<0.01), but no difference in mortality (16% vs 18%, p=0.6). Presence of immunocompromise was associated with lower ICU risk (48% vs 58%, p<0.01), but higher 30 day readmission (20% vs 14%, p=0.03), and no difference in mortality (15% vs 19%, p=0.2). In multivariate analysis, higher mortality was associated with age ≥65 (OR =2.0, 95% CI [1.3, 3.1]) and chronic renal disease (OR = 2.2, 95% CI [1.1, 4.6]), while receipt of appropriate antibiotics (OR = 0.5, 95% CI [0.3, 0.8]) and statin use (OR = 0.4, 95% CI [0.2, 0.8]) were associated with lower mortality.
Conclusion: In this cohort of hospitalized PD patients age ≥50, chronic renal disease was the only comorbidity independently associated with increased mortality. Older adults with chronic renal disease comprise an at-risk population that may benefit from more aggressive targeted pneumococcal prevention.
S. W. Reinhardt,
pfizer: Investigator , Research support