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Chest. Only Severely Limited, Premorbid Functional Status Is Associated With Short- and Long-term Mortality in Patients With Pneumonia Who Are Critically IllA Prospective Observational Study
Only Severely Limited, Premorbid Functional Status Is Associated With Short- and Long-term Mortality in Patients With Pneumonia Who Are Critically Ill (CHEST, abstract, edited)
[Source: Chest, full text: <cite cite="http://chestjournal.chestpubs.org/content/139/1/88.short?rss=1">Only Severely Limited, Premorbid Functional Status Is Associated With Short- and Long-term Mortality in Patients With Pneumonia Who Are Critically Ill ? CHEST</cite>. Abstract, edited.]
Only Severely Limited, Premorbid Functional Status Is Associated With Short- and Long-term Mortality in Patients With Pneumonia Who Are Critically IllA Prospective Observational Study
1. Wendy I. Sligl, MD, 2. Dean T. Eurich, PhD, 3. Thomas J. Marrie, MD and 4. Sumit R. Majumdar, MD
Author Affiliations
1. From the Division of Critical Care Medicine, Faculty of Medicine and Dentistry (Dr Sligl), the Department of Public Health Sciences, School of Public Health (Dr Eurich), and the Department of Medicine, Faculty of Medicine and Dentistry (Dr Majumdar), University of Alberta, Edmonton, AB; and the Department of Medicine, Faculty of Medicine (Dr Marrie), Dalhousie University, Halifax, NS, Canada.
1. Correspondence to: Wendy I. Sligl, MD, Division of Critical Care Medicine, University of Alberta, 3C2.12 Walter Mackenzie Health Sciences Centre, 8440-112th St, Edmonton, AB, T6G 2B7 Canada; e-mail: wsligl@ualberta.ca
Abstract
Background:
Severe pneumonia requiring ICU admission has not been well characterized with respect to long-term outcomes or predictors thereof. We examined the association between premorbid functional status and mortality in patients with severe pneumonia.
Methods:
From 2000 to 2002, a population-based cohort of adults with pneumonia who were critically ill was enrolled and prospectively followed. Short-term (30-day) and long-term (1-year) mortality were examined using multivariable Cox regression models.
Results:
The final cohort included 271 patients, mean age 61 years, 59% men, and 16% from nursing homes. The mean Pneumonia Severity Index was 113 (71% class IV or V), and the mean Acute Physiology and Chronic Health Evaluation II score was 17. Overall, 121 (45%) patients were functionally independent, 115 (42%) had limited mobility, and 35 (13%) were completely dependent. Mortality was 11% at 30 days and 27% at 1 year; by functional status mortality was 6% at 30 days and 17% at 1 year for patients who were independent, 10% and 31% for patients with limited mobility, and 39% and 48% for patients who were dependent. Mortality was greater for patients who were completely dependent when compared with patients who were independent (adjusted hazard ratio [aHR], 5.3; 95% CI, 2.0-14.1; P < .001 at 30 days; and aHR, 3.0; 95% CI, 1.5-6.1; P = .002 at 1 year) or with patients who had limited mobility (aHR, 4.8; 95% CI, 2.0-11.2, P < .001 at 30 days; and aHR, 2.3; 95% CI, 1.3-4,4, P = .007 at 1 year). There were no mortality differences between patients with limited mobility and patients who were independent.
Conclusions:
One-quarter of patients with pneumonia who are critically ill are dead within 1 year. Severely limited premorbid functional status was associated with mortality; this should be considered at presentation for prognosis and at discharge for targeted follow-up.
Footnotes
* Funding/Support: This study was funded by an establishment grant from the Alberta Heritage Foundation for Medical Research, grants-in-aid from Capital Health, and unrestricted grants from Abbott Canada, Pfizer Canada, and Janssen-Ortho Canada (all to Dr Marrie); by the Canadian Institutes of Health Research [MOP 191604] (to Dr Eurich, Dr Marrie, and Dr Majumdar); and by the University of Alberta Hospital Foundation (to Dr Sligl).
* Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (LINK).
#Abbreviationsa: HR adjusted hazard ratio, APACHE Acute Physiology and Chronic Health Evaluation, PSI Pneumonia Severity Index
* Received April 22, 2010.
* Accepted July 7, 2010.
* ? 2011 American College of Chest Physicians
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[Source: Chest, full text: <cite cite="http://chestjournal.chestpubs.org/content/139/1/88.short?rss=1">Only Severely Limited, Premorbid Functional Status Is Associated With Short- and Long-term Mortality in Patients With Pneumonia Who Are Critically Ill ? CHEST</cite>. Abstract, edited.]
Only Severely Limited, Premorbid Functional Status Is Associated With Short- and Long-term Mortality in Patients With Pneumonia Who Are Critically IllA Prospective Observational Study
1. Wendy I. Sligl, MD, 2. Dean T. Eurich, PhD, 3. Thomas J. Marrie, MD and 4. Sumit R. Majumdar, MD
Author Affiliations
1. From the Division of Critical Care Medicine, Faculty of Medicine and Dentistry (Dr Sligl), the Department of Public Health Sciences, School of Public Health (Dr Eurich), and the Department of Medicine, Faculty of Medicine and Dentistry (Dr Majumdar), University of Alberta, Edmonton, AB; and the Department of Medicine, Faculty of Medicine (Dr Marrie), Dalhousie University, Halifax, NS, Canada.
1. Correspondence to: Wendy I. Sligl, MD, Division of Critical Care Medicine, University of Alberta, 3C2.12 Walter Mackenzie Health Sciences Centre, 8440-112th St, Edmonton, AB, T6G 2B7 Canada; e-mail: wsligl@ualberta.ca
Abstract
Background:
Severe pneumonia requiring ICU admission has not been well characterized with respect to long-term outcomes or predictors thereof. We examined the association between premorbid functional status and mortality in patients with severe pneumonia.
Methods:
From 2000 to 2002, a population-based cohort of adults with pneumonia who were critically ill was enrolled and prospectively followed. Short-term (30-day) and long-term (1-year) mortality were examined using multivariable Cox regression models.
Results:
The final cohort included 271 patients, mean age 61 years, 59% men, and 16% from nursing homes. The mean Pneumonia Severity Index was 113 (71% class IV or V), and the mean Acute Physiology and Chronic Health Evaluation II score was 17. Overall, 121 (45%) patients were functionally independent, 115 (42%) had limited mobility, and 35 (13%) were completely dependent. Mortality was 11% at 30 days and 27% at 1 year; by functional status mortality was 6% at 30 days and 17% at 1 year for patients who were independent, 10% and 31% for patients with limited mobility, and 39% and 48% for patients who were dependent. Mortality was greater for patients who were completely dependent when compared with patients who were independent (adjusted hazard ratio [aHR], 5.3; 95% CI, 2.0-14.1; P < .001 at 30 days; and aHR, 3.0; 95% CI, 1.5-6.1; P = .002 at 1 year) or with patients who had limited mobility (aHR, 4.8; 95% CI, 2.0-11.2, P < .001 at 30 days; and aHR, 2.3; 95% CI, 1.3-4,4, P = .007 at 1 year). There were no mortality differences between patients with limited mobility and patients who were independent.
Conclusions:
One-quarter of patients with pneumonia who are critically ill are dead within 1 year. Severely limited premorbid functional status was associated with mortality; this should be considered at presentation for prognosis and at discharge for targeted follow-up.
Footnotes
* Funding/Support: This study was funded by an establishment grant from the Alberta Heritage Foundation for Medical Research, grants-in-aid from Capital Health, and unrestricted grants from Abbott Canada, Pfizer Canada, and Janssen-Ortho Canada (all to Dr Marrie); by the Canadian Institutes of Health Research [MOP 191604] (to Dr Eurich, Dr Marrie, and Dr Majumdar); and by the University of Alberta Hospital Foundation (to Dr Sligl).
* Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (LINK).
#Abbreviationsa: HR adjusted hazard ratio, APACHE Acute Physiology and Chronic Health Evaluation, PSI Pneumonia Severity Index
* Received April 22, 2010.
* Accepted July 7, 2010.
* ? 2011 American College of Chest Physicians
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