Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
Importance of Functional Assessment in the Management of Community-acquired and Healthcare-associated Pneumonia
Kosuke KosaiKoichi IzumikawaYoshifumi ImamuraHironori TanakaMisuzu TsukamotoShintaro KuriharaTakahiro TakazonoYoshitomo MorinagaShigeki NakamuraTaiga MiyazakiKatsunori YanagiharaTakayoshi TashiroShigeru Kohno
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2014 Volume 53 Issue 15 Pages 1613-1620


Objective In Japan, the number of elderly people who have difficulties performing the activities of daily living (ADLs) is increasing. The objective of this study was to assess the relationship between ADL and the clinical characteristics of pneumonia.
Methods We conducted a retrospective study of 219 adult patients hospitalized due to pneumonia [151 patients with community-acquired pneumonia (CAP) and 68 patients with healthcare-associated pneumonia (HCAP)]. CAP, HCAP, and all the patients were stratified into two groups using a modified version of the Katz index of five ADLs as follows: independent in all ADLs or dependent in one to three ADLs (CAP-A, HCAP-A, and All-A groups) and dependent in four or five ADLs (CAP-B, HCAP-B, and All-B groups). Disease severity, microbiological findings, and mortality were compared between the groups.
Results As the ability to perform ADLs declined, A-DROP scores (the CAP severity measurement index) increased significantly in CAP (CAP-A: 1.1±1.1, CAP-B: 2.6±1.1), HCAP (HCAP-A: 2.0±1.0, HCAP-B: 2.8±1.0), and all patients (All-A: 1.3±1.1, All-B: 2.8±1.0). Thirty-day mortality was higher in the CAP-B (23.1%) and All-B (19.2%) groups than in the CAP-A (0.7%) and All-A (1.8%) groups, respectively. A multivariate Cox proportional hazards analysis showed an ADL score ≥ four to be a significant predictor of 30-day mortality in CAP patients [hazard ratio (HR), 19.057; 95% confidence interval (CI), 1.930-188.130] and in all patients (HR, 8.180; 95% CI, 1.998-33.494).
Conclusion A functional assessment using a modified version of the Katz index is useful for the management of CAP and HCAP patients.

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© 2014 by The Japanese Society of Internal Medicine
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