Mortality, morbidity, and disease severity of patients with aspiration pneumonia
Michael J Lanspa, Barbara E Jones, Samuel M Brown, Nathan C Dean, Michael J Lanspa, Barbara E Jones, Samuel M Brown, Nathan C Dean
Abstract
Background: Aspiration pneumonia is a common syndrome, although less well characterized than other pneumonia syndromes. We describe a large population of patients with aspiration pneumonia.
Methods: In this retrospective population study, we queried the electronic medical records at a tertiary-care, university-affiliated hospital from 1996 to 2006. Patients were initially identified by International Classification of Diseases, 9th Revision code 507.x; subsequent physician chart review excluded patients with aspiration pneumonitis and those without a confirmatory radiograph. Patients with community-acquired aspiration pneumonia were compared to a contemporaneous population of community-acquired pneumonia (CAP) patients. We compared CURB-65 (a clinical prediction rule based on Confusion, Uremia, Respiratory rate, Blood Pressure, and age)-predicted mortality with actual 30-day mortality.
Results: We identified 628 patients with aspiration pneumonia, of which 510 were community-acquired. Median age was 77 years, with 30-day mortality of 21%. Compared to CAP patients, patients with community-acquired aspiration pneumonia had more frequent inpatient admission (99% vs 58%) and intensive care unit admission (38% vs 14%), higher Charlson comorbidity index (3 vs 1), and higher prevalence of do not resuscitate/intubate orders (24% vs 11%). CURB-65 predicted mortality poorly in aspiration pneumonia patients (area under the curve, 0.66).
Conclusions: Patients with community-acquired aspiration pneumonia are older, have more comorbidities, and demonstrate higher mortality than CAP patients, even after adjustment for age and comorbidities. CURB-65 poorly predicts mortality in this population.
Copyright © 2012 Society of Hospital Medicine.
Figures
![Figure 1](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/3774007/bin/nihms-510460-f0001.jpg)
![Figure 2](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/3774007/bin/nihms-510460-f0002.jpg)
Figure 3
Receiver-operating characteristic curve, comparing the…
Figure 3
Receiver-operating characteristic curve, comparing the IDSA/ATS minor criteria for severe community-acquired pneumonia against…
Figure 4
Distribution of bacterial organism recovered…
Figure 4
Distribution of bacterial organism recovered from 628 patients with aspiration pneumonia. MRSA =…
- [Pneumonia Severity Index (PSI), CURB-65, and mortality in hospitalized elderly patients with aspiration pneumonia].Heppner HJ, Sehlhoff B, Niklaus D, Pientka L, Thiem U. Heppner HJ, et al. Z Gerontol Geriatr. 2011 Aug;44(4):229-34. doi: 10.1007/s00391-011-0184-3. Z Gerontol Geriatr. 2011. PMID: 21769515 German.
- Risk factors for aspiration in community-acquired pneumonia: analysis of a hospitalized UK cohort.Taylor JK, Fleming GB, Singanayagam A, Hill AT, Chalmers JD. Taylor JK, et al. Am J Med. 2013 Nov;126(11):995-1001. doi: 10.1016/j.amjmed.2013.07.012. Epub 2013 Sep 18. Am J Med. 2013. PMID: 24054176
- Predicting mortality among older adults hospitalized for community-acquired pneumonia: an enhanced confusion, urea, respiratory rate and blood pressure score compared with pneumonia severity index.Abisheganaden J, Ding YY, Chong WF, Heng BH, Lim TK. Abisheganaden J, et al. Respirology. 2012 Aug;17(6):969-75. doi: 10.1111/j.1440-1843.2012.02183.x. Respirology. 2012. PMID: 22574694
- Characteristics associated with clinician diagnosis of aspiration pneumonia: a descriptive study of afflicted patients and their outcomes.Lanspa MJ, Peyrani P, Wiemken T, Wilson EL, Ramirez JA, Dean NC. Lanspa MJ, et al. J Hosp Med. 2015 Feb;10(2):90-6. doi: 10.1002/jhm.2280. Epub 2014 Nov 1. J Hosp Med. 2015. PMID: 25363892 Free PMC article.
- A retrospective survey of treatment and mortality in aspiration pneumonia.Hickling KG, Howard R. Hickling KG, et al. Intensive Care Med. 1988;14(6):617-22. doi: 10.1007/BF00256765. Intensive Care Med. 1988. PMID: 3053842 Review.
- In-hospital mortality for aspiration pneumonia in a tertiary teaching hospital: A retrospective cohort review from 2008 to 2018.Shin D, Lebovic G, Lin RJ. Shin D, et al. J Otolaryngol Head Neck Surg. 2023 Mar 7;52(1):23. doi: 10.1186/s40463-022-00617-2. J Otolaryngol Head Neck Surg. 2023. PMID: 36879258 Free PMC article.
- Development and validation of prediction models for the discharge destination of elderly patients with aspiration pneumonia.Hirota Y, Shin JH, Sasaki N, Kunisawa S, Fushimi K, Imanaka Y. Hirota Y, et al. PLoS One. 2023 Feb 24;18(2):e0282272. doi: 10.1371/journal.pone.0282272. eCollection 2023. PLoS One. 2023. PMID: 36827320 Free PMC article.
- Comprehensive Approaches to Aspiration Pneumonia and Dysphagia in the Elderly on the Disease Time-Axis.Ebihara T. Ebihara T. J Clin Med. 2022 Sep 10;11(18):5323. doi: 10.3390/jcm11185323. J Clin Med. 2022. PMID: 36142971 Free PMC article. Review.
- Retrospective Comparison of the Effectiveness and Safety of Ceftriaxone 1 g Twice Daily versus 2 g Once Daily for Treatment of Aspiration Pneumonia.Kato H, Hagihara M, Morikawa Y, Asai N, Mikamo H, Iwamoto T. Kato H, et al. Antibiotics (Basel). 2022 Jul 22;11(8):983. doi: 10.3390/antibiotics11080983. Antibiotics (Basel). 2022. PMID: 35892373 Free PMC article.
- Predictive value of the videofluoroscopic swallowing study for long-term mortality in patients with subacute stroke.Kim D, Kim JH, Park SW, Han HW, An SJ, Kim YI, Ju HJ, Choi Y, Kim DY. Kim D, et al. Medicine (Baltimore). 2022 Jan 28;101(4):e28623. doi: 10.1097/MD.0000000000028623. Medicine (Baltimore). 2022. PMID: 35089200 Free PMC article.
- Research Support, N.I.H., Extramural
- Research Support, Non-U.S. Gov't
- Adult
- Aged
- Aged, 80 and over
- Female
- Hospital Mortality / trends*
- Humans
- Male
- Middle Aged
- Morbidity
- Pneumonia, Aspiration / diagnosis*
- Pneumonia, Aspiration / mortality*
- Population Surveillance* / methods
- Retrospective Studies
- Severity of Illness Index*
- Full Text Sources
- Medical
- Miscellaneous
![Figure 3](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/3774007/bin/nihms-510460-f0003.jpg)
Figure 4
Distribution of bacterial organism recovered…
Figure 4
Distribution of bacterial organism recovered from 628 patients with aspiration pneumonia. MRSA =…
![Figure 4](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/3774007/bin/nihms-510460-f0004.jpg)
Source: PubMed