Comparison of clinical characteristics and outcomes between aspiration pneumonia and community-acquired pneumonia in patients with chronic obstructive pulmonary disease

Yasuhiro Yamauchi, Hideo Yasunaga, Hiroki Matsui, Wakae Hasegawa, Taisuke Jo, Kazutaka Takami, Kiyohide Fushimi, Takahide Nagase, Yasuhiro Yamauchi, Hideo Yasunaga, Hiroki Matsui, Wakae Hasegawa, Taisuke Jo, Kazutaka Takami, Kiyohide Fushimi, Takahide Nagase

Abstract

Background: Chronic obstructive pulmonary disease (COPD) patients often have dysphagia through age and several co-morbidities, leading to aspiration pneumonia (AsP). COPD patients also have increased risk of developing community-acquired pneumonia (CAP). Using a national inpatient database in Japan, we aimed to compare clinical characteristics and outcomes between AsP and CAP in COPD patients and to verify the factors that affect in-hospital morality.

Methods: We retrospectively collected data on COPD patients (age ≥40 years) who were admitted for AsP or CAP in 1,165 hospitals across Japan between July 2010 and May 2013. We performed multivariable logistic regression analyses to examine the association of various factors with all-cause in-hospital mortality for AsP and CAP.

Results: Of 87,330 eligible patients, AsP patients were more likely to be older, male and have poorer general condition and more severe pneumonia than those with CAP. In-hospital mortality in the AsP group was 22.7% and 12.2% in the CAP group. After adjustment for patient background, AsP patients had significantly higher mortality than CAP patients (adjusted odds ratio, 1.19; 95% confidence interval, 1.08-1.32). Subgroup analyses showed higher mortality to be associated with male gender, underweight, dyspnea, physical disability, pneumonia severity, and several co-morbidities. Further, older age and worse level of consciousness were associated with higher mortality in the CAP group, whereas those were not associated in the AsP group.

Conclusions: Clinical characteristics differed significantly between AsP and CAP in COPD patients. AsP patients had significantly higher mortality than those with CAP.

References

    1. World Health Organization, The top 10 causes of death [] Accessed 14 March 2014.
    1. Global Initiative for Chronic Obstructive Lung Disease, GOLD: Global Strategy for Diagnosis, Management, and prevention of COPD [] Accessed November 23 2014.
    1. Donaldson GC, Seemungal TA, Bhowmik A, Wedzicha JA. Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease. Thorax. 2002;57:847–852. doi: 10.1136/thorax.57.10.847.
    1. Connors AF, Jr, Dawson NV, Thomas C, Harrell FE, Jr, Desbiens N, Fulkerson WJ, Kussin P, Bellamy P, Goldman L, Knaus WA. Outcomes following acute exacerbation of severe chronic obstructive lung disease. The SUPPORT investigators (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments) Am J Respir Crit Care Med. 1996;154:959–967. doi: 10.1164/ajrccm.154.4.8887592.
    1. Sethi S, Murphy TF. Infection in the pathogenesis and course of chronic obstructive pulmonary disease. N Engl J Med. 2008;359:2355–2365. doi: 10.1056/NEJMra0800353.
    1. Torres A, Dorca J, Zalacain R, Bello S, El-Ebiary M, Molinos L, Arevalo M, Blanquer J, Celis R, Iriberri M, Prats E, Fernandez R, Irigaray R, Serra J. Community-acquired pneumonia in chronic obstructive pulmonary disease: a Spanish multicenter study. Am J Respir Crit Care Med. 1996;154:1456–1461. doi: 10.1164/ajrccm.154.5.8912764.
    1. Torres A, Serra-Batlles J, Ferrer A, Jimenez P, Celis R, Cobo E, Rodriguez-Roisin R. Severe community-acquired pneumonia. Epidemiology and prognostic factors. Am Rev Respir Dis. 1991;144:312–318. doi: 10.1164/ajrccm/144.2.312.
    1. Restrepo MI, Mortensen EM, Pugh JA, Anzueto A. COPD is associated with increased mortality in patients with community-acquired pneumonia. Eur Respir J. 2006;28:346–351. doi: 10.1183/09031936.06.00131905.
    1. Holguin F, Folch E, Redd SC, Mannino DM. Comorbidity and mortality in COPD-related hospitalizations in the United States, 1979 to 2001. Chest. 2005;128:2005–2011. doi: 10.1378/chest.128.4.2005.
    1. Marik PE. Pulmonary aspiration syndromes. Curr Opin Pulm Med. 2011;17:148–154. doi: 10.1097/MCP.0b013e32834397d6.
    1. 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. doi: 10.1016/j.amjmed.2013.07.012.
    1. Hayashi M, Iwasaki T, Yamazaki Y, Takayasu H, Tateno H, Tazawa S, Kato E, Wakabayashi A, Yamaguchi F, Tsuchiya Y, Yamashita J, Takeda N, Matsukura S, Kokubu F. Clinical features and outcomes of aspiration pneumonia compared with non-aspiration pneumonia: a retrospective cohort study. J Infect Chemother. 2014;20:436–442. doi: 10.1016/j.jiac.2014.04.002.
    1. Cabre M. Pneumonia in the elderly. Curr Opin Pulm Med. 2009;15:223–229. doi: 10.1097/MCP.0b013e328326f571.
    1. Terada K, Muro S, Ohara T, Kudo M, Ogawa E, Hoshino Y, Hirai T, Niimi A, Chin K, Mishima M. Abnormal swallowing reflex and COPD exacerbations. Chest. 2010;137:326–332. doi: 10.1378/chest.09-0482.
    1. Clayton NA, Carnaby GD, Peters MJ, Ing AJ. Impaired laryngopharyngeal sensitivity in patients with COPD: The association with swallow function. Int J Speech Lang Pathol. 2014;16:615–623. doi: 10.3109/17549507.2014.882987.
    1. Clayton NA, Carnaby-Mann GD, Peters MJ, Ing AJ. The effect of chronic obstructive pulmonary disease on laryngopharyngeal sensitivity. Ear Nose Throat J. 2012;91:370–372.
    1. Ohta T, Waga S, Handa W, Saito I, Takeuchi K. [New grading of level of disordered consiousness (author's transl)] No Shinkei Geka. 1974;2:623–627.
    1. Todo T, Usui M, Takakura K. Treatment of severe intraventricular hemorrhage by intraventricular infusion of urokinase. J Neurosurg. 1991;74:81–86. doi: 10.3171/jns.1991.74.1.0081.
    1. Mahoney FI, Barthel DW. Functional evaluation: the Barthel index. Md State Med J. 1965;14:61–65.
    1. Shindo Y, Sato S, Maruyama E, Ohashi T, Ogawa M, Imaizumi K, Hasegawa Y. Comparison of severity scoring systems A-DROP and CURB-65 for community-acquired pneumonia. Respirology. 2008;13:731–735. doi: 10.1111/j.1440-1843.2008.01329.x.
    1. Hubbard AE, Ahern J, Fleischer NL, Van der Laan M, Lippman SA, Jewell N, Bruckner T, Satariano WA. To GEE or not to GEE: comparing population average and mixed models for estimating the associations between neighborhood risk factors and health. Epidemiology. 2010;21:467–474. doi: 10.1097/EDE.0b013e3181caeb90.
    1. Dang TT, Majumdar SR, Marrie TJ, Eurich DT. Recurrent pneumonia: a review with focus on clinical epidemiology and modifiable risk factors in elderly patients. Drugs Aging. 2015;32:13–19. doi: 10.1007/s40266-014-0229-6.
    1. Kikuchi R, Watabe N, Konno T, Mishina N, Sekizawa K, Sasaki H. High incidence of silent aspiration in elderly patients with community-acquired pneumonia. Am J Respir Crit Care Med. 1994;150:251–253. doi: 10.1164/ajrccm.150.1.8025758.
    1. Kobayashi S, Kubo H, Yanai M. Impairment of the swallowing reflex in exacerbations of COPD. Thorax. 2007;62:1017. doi: 10.1136/thx.2007.084715.
    1. Stein M, Williams AJ, Grossman F, Weinberg AS, Zuckerbraun L. Cricopharyngeal dysfunction in chronic obstructive pulmonary disease. Chest. 1990;97:347–352. doi: 10.1378/chest.97.2.347.
    1. Singh B, Mielke MM, Parsaik AK, Cha RH, Roberts RO, Scanlon PD, Geda YE, Christianson TJ, Pankratz VS, Petersen RC. A prospective study of chronic obstructive pulmonary disease and the risk for mild cognitive impairment. JAMA Neurol. 2014;71:581–588. doi: 10.1001/jamaneurol.2014.94.
    1. Moon HI, Pyun SB, Kwon HK. Correlation between Location of Brain Lesion and Cognitive Function and Findings of Videofluoroscopic Swallowing Study. Ann Rehabil Med. 2012;36:347–355. doi: 10.5535/arm.2012.36.3.347.
    1. Marik PE. Aspiration pneumonitis and aspiration pneumonia. N Engl J Med. 2001;344:665–671. doi: 10.1056/NEJM200103013440908.
    1. Komiya K, Ishii H, Umeki K, Mizunoe S, Okada F, Johkoh T, Kadota J. Impact of aspiration pneumonia in patients with community-acquired pneumonia and healthcare-associated pneumonia: a multicenter retrospective cohort study. Respirology. 2013;18:514–521. doi: 10.1111/resp.12029.
    1. Reza Shariatzadeh M, Huang JQ, Marrie TJ. Differences in the features of aspiration pneumonia according to site of acquisition: community or continuing care facility. J Am Geriatr Soc. 2006;54:296–302. doi: 10.1111/j.1532-5415.2005.00608.x.
    1. Tejerina E, Frutos-Vivar F, Restrepo MI, Anzueto A, Palizas F, Gonzalez M, Apezteguia C, Abroug F, Matamis D, Bugedo G, Esteban A. Prognosis factors and outcome of community-acquired pneumonia needing mechanical ventilation. J Crit Care. 2005;20:230–238. doi: 10.1016/j.jcrc.2005.05.010.

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