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

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

doi:10.1186/s12890-015-0064-5

Abstract

BackgroundChronic 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.MethodsWe 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.ResultsOf 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.ConclusionsClinical characteristics differed significantly between AsP and CAP in COPD patients. AsP patients had significantly higher mortality than those with CAP.Electronic supplementary materialThe online version of this article (doi:10.1186/s12890-015-0064-5) contains supplementary material, which is available to authorized users.

Highlights

Chronic obstructive pulmonary disease (COPD) patients often have dysphagia through age and several co-morbidities, leading to aspiration pneumonia (AsP)
The database contains the following details: patient’s age, sex, body height, and weight; severity of dyspnea based on the Hugh-Jones dyspnea scale; level of consciousness based on the Japan Coma Scale [17, 18] on admission; grades of activities of daily life on admission converted to the Barthel index [19]; severity of pneumonia based on the A-DROP score; admission to intensive care unit (ICU) during hospitalization; mechanical ventilation; outcome; and discharge status
Comparison of clinical characteristics between AsP and community-acquired pneumonia (CAP) in patients with COPD We identified 87,330 patients with COPD who were admitted for pneumonia; 16,388 had AsP, and 70,942 had CAP

Summary

Introduction

Chronic obstructive pulmonary disease (COPD) patients often have dysphagia through age and several co-morbidities, leading to aspiration pneumonia (AsP). AsP demonstrates specific clinical features [10, 11], such as frequent occurrence in elderly patients, greater severity of pneumonia, and poorer long-term mortality compared with CAP [11,12,13]. COPD patients have been reported to have increased risk of dysphagia, which is related to the occurrence of AsP. This dysphagia is due to ageing [13] and to the presence of cerebrovascular disease [11] and gastro-oesophageal reflux disease [14] as co-morbidities of COPD. AsP should be considered in the differential diagnosis in COPD patients with exacerbation who require hospitalization

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