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Extremely Poor Post-discharge Prognosis in Aspiration Pneumonia and Its Prognostic Factors: A Retrospective Cohort Study

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Abstract

There is little evidence regarding the long-term prognosis of patients with aspiration pneumonia. This study aimed to investigate post-discharge survival time and prognostic factors in older patients hospitalized for aspiration pneumonia. This retrospective cohort study included patients aged ≥ 65 years hospitalized for aspiration pneumonia and discharged alive from a tertiary care hospital in Japan between April 2009 and September 2014. Candidate prognostic factors were patient’s age, sex, body mass index (BMI), performance status, chronic conditions, CURB-65 score, serum albumin level, hematocrit concentration, nutritional pathway at discharge, and discharge location. Kaplan–Meier curves were determined and multivariable survival analysis using Cox regression model was performed to analyze the effect of each factor on mortality. In total, 209 patients were included in this study. The median age was 85 years, 58% of the patients were males, 33% had a performance status of 4 and 34% were discharged home. Among the patients, 65% received oral intake, 23% received tube feeding, and 21% received parenteral nutrition at discharge. During the follow-up period, 77% of the patients died, and the median post-discharge survival time was 369 days. Besides male sex and low BMI, tube feeding (adjusted hazard ratio (aHR) = 1.70, 95% confidence interval (CI) 1.11–2.59) and parenteral nutrition (aHR = 4.42, 95% CI 2.57–7.60) were strongly associated with mortality. Long-term prognosis of patients hospitalized for aspiration pneumonia was extremely poor. The nutritional pathway at discharge was a major prognostic factor. These results may be useful for future care and research.

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Data Availability

The datasets generated during and/or analyzed during the current study are not publicly available because they contain information that could compromise the privacy of research participants, but are available from the corresponding author on reasonable request.

References

  1. Bennett J, Vella C. Aspiration pneumonia. BMJ Best Practice. https://bestpractice.bmj.com/topics/en-gb/3000171 (2023). Accessed 16 Nov 2023.

  2. Langmore SE, Terpenning MS, Schork A, Chen Y, Murray JT, Lopatin D, et al. Predictors of aspiration pneumonia: how important is dysphagia? Dysphagia. 1998;13:69–81.

    Article  CAS  PubMed  Google Scholar 

  3. Cabre M, Serra-Prat M, Palomera E, Almirall J, Pallares R, Clavé P. Prevalence and prognostic implications of dysphagia in elderly patients with pneumonia. Age Ageing. 2009;39:39–45.

    Article  PubMed  Google Scholar 

  4. Ministry of Health, Labour and Welfare. Reiwa ni nen kanja tyōsa no gaikyō. https://www.mhlw.go.jp/toukei/saikin/hw/kanja/20/index.html. Accessed 16 Nov 2023.

  5. Wu CP, Chen YW, Wang MJ, Pinelis E. National trends in admission for aspiration pneumonia in the United States, 2002–2012. Ann Am Thorac Soc. 2017;14:874–9.

    Article  PubMed  Google Scholar 

  6. Palacios-Ceña D, Hernández-Barrera V, López-de-Andrés A, Fernández-de-las-Peñas C, Palacios-Ceña M, de Miguel-Díez J, et al. Time trends in incidence and outcomes of hospitalizations for aspiration pneumonia among elderly people in Spain (2003–2013). Eur J Intern Med. 2017;38:61–7. https://doi.org/10.1016/j.ejim.2016.12.022.

    Article  PubMed  Google Scholar 

  7. Gupte T, Knack A, Cramer JD. Mortality from aspiration pneumonia: incidence, trends, and risk factors. Dysphagia. 2022;37:1493–500. https://doi.org/10.1007/s00455-022-10412-w.

    Article  PubMed  Google Scholar 

  8. Ministry of Health, Labour and Welfare. Reiwa yo nen jinkō dōtai tōkei no gaikyō. https://www.mhlw.go.jp/toukei/saikin/hw/jinkou/kakutei22/index.html. Accessed 16 Nov 2023.

  9. Teramoto S, Fukuchi Y, Sasaki H, Sato K, Sekizawa K, Matsuse T, et al. High incidence of aspiration pneumonia in community- and hospital-acquired pneumonia in hospitalized patients: a multicenter, prospective study in Japan. J Am Geriatr Soc. 2008;56:577–9.

    Article  PubMed  Google Scholar 

  10. Komiya K, Ishii H, Kadota JI. Healthcare-associated pneumonia and aspiration pneumonia. Aging Dis. 2015;6:27–37.

    Article  PubMed  Google Scholar 

  11. Momosaki R, Yasunaga H, Matsui H, Horiguchi H, Fushimi K, Abo M. Predictive factors for oral intake after aspiration pneumonia in older adults. Geriatr Gerontol Int. 2016;16:556–60.

    Article  PubMed  Google Scholar 

  12. ASPENB Directors, Jacobs DO, Helton S. Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. J Parenter Enter Nutr. 2002;26:1SA-138SA.

    Google Scholar 

  13. Komiya K, Usagawa Y, Kadota JI, Ikegami N. Decreasing use of percutaneous endoscopic gastrostomy tube feeding in Japan. J Am Geriatr Soc. 2018;66:1388–91.

    Article  PubMed  Google Scholar 

  14. Taylor JK, Fleming GB, Singanayagam A, Hill AT, Chalmers JD. Risk factors for aspiration in community-acquired pneumonia: analysis of a hospitalized UK cohort. Am J Med. 2013;126:995–1001.

    Article  PubMed  Google Scholar 

  15. Kim H, Jo S, Lee JB, Jin Y, Jeong T, Yoon J, et al. Diagnostic performance of initial serum albumin level for predicting in-hospital mortality among aspiration pneumonia patients. Am J Emerg Med. 2018;36:5–11. https://doi.org/10.1016/j.ajem.2017.06.039.

    Article  PubMed  Google Scholar 

  16. Maeda K, Akagi J. Muscle mass loss is a potential predictor of 90-day mortality in older adults with aspiration pneumonia. J Am Geriatr Soc. 2017;65:e18-22.

    Article  PubMed  Google Scholar 

  17. Yoon HY, Shim SS, Kim SJ, Lee JH, Chang JH, Lee SH, et al. Long-term mortality and prognostic factors in aspiration pneumonia. J Am Med Dir Assoc. 2019;20:1098-1104.e4. https://doi.org/10.1016/j.jamda.2019.03.029.

    Article  PubMed  Google Scholar 

  18. Yoshimatsu Y, Melgaard D, Westergren A, Skrubbeltrang C, Smithard DG. The diagnosis of aspiration pneumonia in older persons: a systematic review. Eur Geriatr Med. 2022;13:1071–80. https://doi.org/10.1007/s41999-022-00689-3.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Komiya K, Rubin BK, Kadota JI, Mukae H, Akaba T, Moro H, et al. Prognostic implications of aspiration pneumonia in patients with community acquired pneumonia: a systematic review with meta-analysis. Sci Rep. 2016;6:1–2.

    Article  Google Scholar 

  20. Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious Diseases Society of America/American Thoracic Society Consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44:S27.

    Article  CAS  PubMed  Google Scholar 

  21. Cichero JAY, Lam P, Steele CM, Hanson B, Chen J, Dantas RO, et al. Development of international terminology and definitions for texture-modified foods and thickened fluids used in dysphagia management: the IDDSI framework. Dysphagia. 2017;32:293–314.

    Article  PubMed  Google Scholar 

  22. Holter JC, Ueland T, Jenum PA, Müller F, Brunborg C, Frøland SS, et al. Risk factors for long-term mortality after hospitalization for community-acquired pneumonia: a 5-year prospective follow-up study. PLoS ONE. 2016;211:1–16.

    Google Scholar 

  23. Johnstone J, Eurich DT, Majumdar SR, Jin Y, Marrie TJ. Long-term morbidity and mortality after hospitalization with community-acquired pneumonia: a population-based cohort study. Medicine (Baltimore). 2008;87:329–34.

    Article  PubMed  Google Scholar 

  24. Noguchi S, Yatera K, Kato T, Chojin Y, Fujino Y, Akata K, et al. Impact of the number of aspiration risk factors on mortality and recurrence in community-onset pneumonia. Clin Interv Aging. 2017;12:2087–94.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Ebihara T, Miyamoto T, Kozaki K. Prognostic factors of 90-day mortality in older people with healthcare-associated pneumonia. Geriatr Gerontol Int. 2020;20:1036–43.

    Article  PubMed  Google Scholar 

  26. Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982;5:649–55.

    Article  CAS  PubMed  Google Scholar 

  27. Lim WS, Van Der Eerden MM, Laing R, Boersma WG, Karalus N, Town GI, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 2003;58:377–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Ministry of Health, Labour and Welfare. Dai 21 kai seimeihyō no gaikyō. https://www.mhlw.go.jp/toukei/saikin/hw/life/21th/index.html. Accessed 16 Nov 2023.

  29. Masaki S, Kawamoto T. Comparison of long-term outcomes between enteral nutrition via gastrostomy and total parenteral nutrition in older persons with dysphagia: a propensity-matched cohort study. PLoS ONE. 2019;14:1–12. https://doi.org/10.1371/journal.pone.0217120.

    Article  MathSciNet  CAS  Google Scholar 

  30. Reade MC, Weissfeld L, Angus DC, Kellum JA, Milbrandt EB. The prevalence of anemia and its association with 90-day mortality in hospitalized community-acquired pneumonia. BMC Pulm Med. 2010. https://doi.org/10.1186/1471-2466-10-15.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Stauder R, Valent P, Theurl I. Anemia at older age: etiologies, clinical implications, and management. Blood. 2018;131:505–14.

    Article  CAS  PubMed  Google Scholar 

  32. Nishida T, Yamabe K, Honda S. The influence of dysphagia on nutritional and frailty status among community-dwelling older adults. Nutrients. 2021;13:1–8.

    Article  Google Scholar 

  33. Sakai K, Nakayama E, Yoneoka D, Sakata N, Iijima K, Tanaka T, et al. Association of oral function and dysphagia with frailty and sarcopenia in community-dwelling older adults: a systematic review and meta-analysis. Cells. 2022;11:2199.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Park CM, Kim W, Rhim HC, Lee ES, Kim JH, Cho KH, et al. Frailty and hospitalization-associated disability after pneumonia: a prospective cohort study. BMC Geriatr. 2021;21:1–8.

    Article  Google Scholar 

  35. Dorner B, Posthauer ME, Friedrich EK, Robinson GE. Enteral nutrition for older adults in nursing facilities. Nutr Clin Pract. 2011;26:261–72.

    Article  PubMed  Google Scholar 

  36. Bellelli G, Frisoni GB, Trabucchi M. Feeding tube use in Italian nursing homes: the role of cultural factors. J Am Med Dir Assoc. 2005;6:87–8.

    Article  PubMed  Google Scholar 

  37. Aita K, Takahashi M, Miyata H, Kai I, Finucane TE. Physicians’ attitudes about artificial feeding in older patients with severe cognitive impairment in Japan: a qualitative study. BMC Geriatr. 2007;7:1–9.

    Article  Google Scholar 

  38. Komiya K, Ishii H, Teramoto S, Yasuda T, Sato S, Yamamoto H, et al. Medical professionals’ attitudes toward tube feeding for themselves or their families: a multicenter survey in Japan. J Palliat Med. 2012;15:561–6.

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors are grateful to the hospitals and care facilities from which the patients were discharged for providing prognostic data.

Funding

This research did not receive any funding from agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of General Internal Medicine, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Chuo-ku, Hamamatsu, Shizuoka, 430-8558, Japan

    Yuki Honda MD, Yoichiro Homma MD, PhD, MPH & Kazuhito Saito MD

  2. Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Chuo-ku, Hamamatsu, Shizuoka, 431-3192, Japan

    Yuki Honda MD, Mieko Nakamura MD, PhD & Toshiyuki Ojima MD, PhD

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  1. Yuki Honda MD
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  5. Kazuhito Saito MD
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Contributions

All authors (YH, YH, MN, TO, and KS) contributed to the conception or design of the study, reviewed and edited the manuscript, contributed to the interpretation of the data and the analyses, performed a critical review of the manuscript, and gave the final approval of the manuscript before submission. YH, YH, and KS collected the patient data. YH performed the statistical analyses and drafted the manuscript. YH, MN, TO, and KS supervised the work.

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Correspondence to Yuki Honda MD.

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The authors declare no conflict of interest.

Ethical Approval

The Ethics Committees of the institutions approved the study protocol (research approval no. 3529 and 20–311) and waived the requirement for informed consent because of the retrospective nature of the study.

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Information about the study was displayed on the institution's website and refusal to participate in the study was received.

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Honda, Y., Homma, Y., Nakamura, M. et al. Extremely Poor Post-discharge Prognosis in Aspiration Pneumonia and Its Prognostic Factors: A Retrospective Cohort Study. Dysphagia (2024). https://doi.org/10.1007/s00455-023-10665-z

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