Dementia Increases Mortality Risk in Patients With Community-Acquired Pneumonia

Real-world evidence suggests community-acquired pneumonia (CAP) mortality rates are significantly higher among patients with vs without dementia, according to study results published in PLoS One.

Investigators from the Universidad de La Sabana retrospectively reviewed data from 2 tertiary care institutions in Colombia. Adults (N=3374) diagnosed with CAP between 2010 and 2020 were evaluated for mortality on the basis of dementia status.

Among patients with (n=354) and without (n=3020) dementia, the mean (SD) ages were 82.5 (10.94) and 63.5 (21.49) years and 53.7% and 60.5% were men, respectively. Patients with dementia had higher rates of all comorbidities relative to control individuals.

This population, characterized by advanced age, multiple comorbidities, and greater disease severity, highlights the need to implement specific and multidisciplinary clinical management strategies.

Patients with dementia presented with significantly lower leukocyte, hemoglobin, hematocrit, and platelet levels coupled with higher sodium and blood urea nitrogen levels (all P <.001).

Chest x-rays revealed more severe lung effects in patients with vs without dementia, with higher rates of alveolar infiltrates (82.5% vs 66.5%; P <.001), consolidation (79.7% vs 64.9%; P <.001), interstitial infiltrates (65.5% vs 48.1%; P <.001), and multilobar involvement (40.7% vs 22.4%; P <.001) and less pleural effusion (15% vs 15.3%; P =.004).

Patients with vs without dementia were more likely to require hospitalization (96.6% vs 89.1%; P <.001), develop septic shock (15% vs 9.5%; P =.001), receive invasive mechanical ventilation (5.6% vs 9.3%; P =.022), and be admitted to the intensive care unit (ICU; 8.8% vs 13.2%; P =.017).

Patients with dementia had a higher mortality rate at 30 days (26.3%) than control individuals (7.1%; P <.001). Mortality at 30 days was associated with dementia (hazard ratio [HR], 2.28; 95% CI, 1.756-2.962; P <.001), ICU admission (HR, 1.46; 95% CI, 1.091-1.967; P =.011), and Pneumonia Severity Index (HR, 1.02; 95% CI, 1.023-1.029; P <.001).

Study limitations include the retrospective design and lack of assessment of patient access to palliative care.

The investigators concluded, “This population, characterized by advanced age, multiple comorbidities, and greater disease severity, highlights the need to implement specific and multidisciplinary clinical management strategies.”

This article originally appeared on Infectious Disease Advisor