Risk factors for pneumonia-associated mortality on autopsy-confirmed patients with dementia

Abstract

Backgrounds: In patients with dementia, pneumonia is a common complication and a leading cause of death. The risk factors for pneumonia-associated mortality in dementia have not been fully elucidated. Methods: We conducted a retrospective study by the reviews on medical charts and autopsy reports of 204 patients who admitted and received post-mortem examination in a hospital in Japan. Data on general characteristics, clinical conditions, subtypes of dementia and underlying- and immediate-causes of death were collected and compared between patients with pneumonia-associated mortality (n=76) vs. non-pneumonia-associated mortality (n=128) in the underlying cause and between those with pneumonia-associated mortality (n=90) vs. non-pneumonia-associated mortality (n=114) in the immediate cause. The risk factors to pneumonia-associated mortality were evaluated using logistic regression analysis both in underlying- and immediate-causes of death. Results: Pneumonia is the most major cause of death on patients with dementia. The higher frequency of pneumonia-associated mortality was observed in the immediate cause of death (44.1%) comparing those in the underlying cause (37.3%). The multivariate analysis demonstrated that the risk factors to the pneumonia-associated mortality (underlying) were dysphagia (Odds ratio [OR], 2.030; 95% confidence interval [CI], 1.039-3.966) and diabetes mellitus (OR, 3.109; 95%CI, 1.182-8.174). On the contrary, the risk factor to the pneumonia-associated mortality (immediate) was only Gender-male (OR, 2.474; 95%CI, 1.332-4.596). Conclusion: Careful treatments for dysphagia and diabetes mellitus are crucial for maximizing the life of patients with dementia.