Nutrition, Pneumonia Severity May Predict Life Expectancy From Aspiration Pneumonia

Nutritional status and severity of pneumonia are important factors for predicting life expectancy in patients with aspiration pneumonia, according to a recent study published in The Clinical Respiratory Journal. Additionally, men were found to have lower survival rates compared with women.

“Aspiration pneumonia is a dominant form of CAP [community-acquired pneumonia] and health care–associated pneumonia and a leading cause of death in an ageing society,” wrote the authors. “However, reports on the risk factors of mortality for aspiration pneumonia are limited.”

They conducted a retrospective observational study evaluating the risk factors for 90-day survival among patients with aspiration pneumonia to confirm the longer-term effects of these risk factors at Seirei Mikatahara General Hospital in Shizuoka, Japan between April 1, 2015, and March 31, 2016. Patients with aspiration pneumonia were included if they had dysphagia or aspiration confirmed by modified water swallow test or video endoscopic examination of swallowing. The primary end point was 90-day survival, categorized as late survival by previous studies.

Univariate and multivariate logistic regression analyses accounted for survival and nonsurvival at 90 days as the independent variables. Twenty-eight items overall were compared between the survival and nonsurvival groups. The mean (SD) age of patients (N = 276) was 80.8 (12.9) years, and 65.5% were men.

Of the study population, 231 were survivors and 45 were nonsurvivors. Significant differences were found in 11 items between groups.

While there was no significant difference in age or length of hospitalization between groups, the nonsurvival group had a higher disease severity—marked by increased inflammation levels of C-reactive protein, white blood cell count, and dehydration—and percentage of male patients. In both groups, inflammation levels were found to be high, and dehydration was observed.

The multivariate regression analysis included A-DROP scores measuring severity, Geriatric Nutritional Risk Index (GNRI) scores, and sex. The results showed that A-DROP score (odds ratio [OR], 2.440; 95% CI, 1.400-4.270; P < .01), GNRI (OR, 0.383; 95% CI, 0.178-0.824; P < .05), and sex (OR, 0.365; 95% CI, 0.153-0.869; P < .05) were independent early predictors of mortality.

The researchers also performed a Kaplan-Meier analysis for A-DROP, GNRI, and sex. Men had lower survival rates compared with women (log-rank test, P = .012), A-DROP had significantly higher mortality rates with increasing severity of illness (log-rank test, P < .001), and the GNRI showed significantly higher mortality rates with an increasing risk of nutritional disorders (log-rank test, P < .01).

Although the GNRI is an indicator of nutritional disorder–related complications and not a nutritional indicator itself, the association between low GNRI scores and increased mortality indicates that low nutrition may have significant effects on patients with aspiration pneumonia.

The authors suggest that factors related to feeding may influence low nutrition for patients with aspiration pneumonia.

Overall, the authors’ analyses indicate that nutritional status and pneumonia severity can predict life expectancy in patients with aspiration pneumonia. The authors recommend assessing nutritional status in addition to severity of disease at time of admission.

The study faced limitations due to its retrospective, single-center design.

The authors suggest further research be conducted in detailed, multicenter, prospective studies to improve the care and rehabilitation of the growing number of patients with aspiration pneumonia.

Reference

Yanagita Y, Arizono S, Tawara Y, Oomagari M, Machiguchi H, Yokomura K, et al. The severity of nutrition and pneumonia predicts survival in patients with aspiration pneumonia: a retrospective observational study. Clin Respir J. Published online July 5, 2022. doi:10.1111/crj.13521