2020 Volume 24 Issue 3 Pages 247-257
Purpose: Few studies about the medium- to long-term survival of patients with aspiration pneumonia have been reported. The purpose of this study was to clarify the medium- to long-term survival of patients with aspiration pneumonia and the prognostic factors influencing survival.
Methods: This was an observational retrospective cohort study. Aspiration pneumonia inpatients who consulted the Department of Otorhinolaryngology for an evaluation of swallowing from April 2018 to March 2019 were surveyed. Inclusion criteria were that the chief cause of hospitalization was aspiration pneumonia and not secondary to acute cerebrovascular disease. Cases who died in the acute phase of pneumonia before swallowing evaluation were also excluded. We analyzed the factors related to the prognosis of aspiration pneumonia by multivariate analysis and calculated the hazard ratio (HR). Those were age (three groups: 74 years old or under, 75–89 years old, 90 years old or over), gender, dysphagia severity scale (two group: within normal limits to occasional aspiration, water aspiration to saliva aspiration), activities of daily living (two groups: non bedridden, bedridden), body mass index (three groups: BMI over 18.5, 18.5–16, under 16), induction of alternative nutrition and pre- and co-existing disease (past history of pneumonia, past history of cerebrovascular disease, Parkinson’s disease, dementia, hypertension, diabetes mellitus). Survival, days alive, and induction of alternative nutrition were investigated by telephone from January to April 2020.
Results: 109 patients with aspiration pneumonia (median age: 86 years old) were analyzed. Only five cases were 64 years old or under, 104 were geriatric patients over 65 years old. 67 cases died during the studied period and 42 remained alive. The median period of remaining alive was 254 days, the survival rate of 6th months was 54.8% and that of 1 year was 41.8%. The HR of prognostic factors were age: 1.76, male: 1.78, swallow under water aspiration: 2.01, bedridden: 2.39, low BMI: 1.60 and induction of alternative nutrition: 0.27. Only Parkinson’s disease mitigated the prognosis of aspiration pneumonia (HR 5.00) among pre- and co-existing diseases.
Conclusion: More than half of the aspiration pneumonia patients died within 1 year. Elderly, male, swallow under water aspiration, bedridden and low BMI were risk factors of survival. Induction of alternative nutrition had a good influence on the prognosis. Parkinson’s disease mitigated the prognosis.
