PURPOSE:Functional status has been identified in several studies as a predictor of poor outcome in patients hospitalized with Pneumonia. It is also known that patients with Healthcare-associated pneumonia (HCAP) (that includes patients from Skilled Nursing Facilities - SNF) have a poorer outcome than Community-acquired Pneumonia (CAP) . A recent case-control study showed that in elderly patients with severe impairment in functional status, the differences in place of origin (community vs SNF) lose its importance, compared to functional status. We studied the impact of poor Functional Status in a cohort of patients with both CAP and HCAP.
METHODS:Prospective analysis of patients admitted to Winthrop University Hospital from July, 07 to April,08 with a diagnosis of HCAP or CAP. Patients’ demographical data, clinical presentation and severity of disease and outcomes were evaluated. Chi-square tests were used for categorical variables, t-tests for normally distributed continuous variables, and Mann-Whitney tests for non-normally distributed continuous variables. A stepwise multiple logistic regression model was used for statistical analysis.
RESULTS:55 patients (24.6%) had HCAP (30.9% from SNF) and 169 patients (75.4%) had CAP. HCAP patients were older 74.7+/− 14.8y vs 68.7 +/− 16.6y (p<0.05). PSI score was 110.7+/− 34.9 for HCAP vs 92.1+/− 32.8 for CAP (p<0.01) and CURB-65 was 2.1+/− 1.1 vs 1.7+/− 1 for CAP (p<0.05). Barthel’s index of functional staus was 65.9+/− 37.9 for HCAP vs 92.7+/− 18.5 for CAP (p<0.01). Mortality was significantly higher for patients with marked impairment in the ADLs. In a multivariate analysis, Barthel Index correlated with mortality for all patients.
CONCLUSION:Impaired functional status itself is a significant predictor of worse outcome in both CAP and HCAP. This may explain the higher mortality in HCAP vs. CAP, since HCAP patients are more likely to have impaired functional status than CAP patients.
CLINICAL IMPLICATIONS:It is possible that focusing therapy on the group of functionally impaired patients with both CAP and HCAP may improve outcomes.
DISCLOSURE:Veronica Brito, None.