Is there a correlation between co-morbidities and initial severity score of pneumonia in patients admitted with community acquired pneumonia? – a retrospective study
- Author:
Vaani Valerie Visuvanathan
;
Hui Min Chong
;
Shien Yee Ng
;
Chen Nee Ch’ng
;
Juliana Shook Shin Tan
;
Sree Viknaraja Arun Kumar
;
Ming Wai Wan
- Publication Type:Journal Article
- Keywords:
Co-morbidities;
CURB-65 risk score;
Community Acquired Pneumonia, retrospective, random sampling
- MeSH:
Morbidity
- From:International e-Journal of Science, Medicine and Education
2015;9(1):32-37
- CountryMalaysia
- Language:English
-
Abstract:
Background: Community-acquired pneumonia (CAP)
is the most important cause of hospitalisation in Malaysia
and the 6th most important cause of mortality in patients
aged 65 years and above. CAP is a lower respiratory tract
infection that includes signs and symptoms like cough,
fever, dyspnoea, the presence of new focal chest signs
and new radiographic shadowing with no prior cause.
To assist clinical judgement in deciding whether to
admit the patient for in-ward treatment or otherwise,
the severity of CAP is most commonly graded using
the CURB-65 score as the components are more
readily accessible in the Accidents and Emergency
Department. We believe that cardiopulmonary diseases,
immunosuppressive diseases like HIV infection or
diabetes mellitus and other co-morbidities may affect
the severity of CAP and are thus aspects of a patients’
history that should play a more significant role in
influencing a clinician’s judgement of CAP severity.
The general objective of the study is therefore to identify
the relationship between co-morbidities and initial
severity assessment of a patient admitted for community
acquired pneumonia. The 3 specific objectives are i) to
determine if presence of co-morbidities affects initial
severity assessment in a patient admitted with CAP ii)
To identify which co-morbidities affects initial severity
assessment and iii) to determine whether having multiple
co-morbidities increases initial severity assessment.
Methodology: A retrospective study was carried out from
the month of February 2013 to July 2013 at Hospital
Tuanku Ja’afar, Seremban (HTJS). Patients admitted to
the four Medical wards – 6A, 6B, 7A, and 7B – from
July 2012 to December 2012 and have been diagnosed
with CAP were chosen. A checklist was used as a survey
instrument. Using statistical analysis, the severity of
CAP in patients was compared in patients with different
factors like gender, different co-morbidities and the
number of co-morbidities.
Results: A total of 63 patients in the control group
had no co-morbidities and 54 patients were of low risk,
7 patients had moderate risk, and 2 patients had high
risk CAP. Of the remaining 337 patients in the sample population, 124 patients had one co-morbidity, while
213 patients had multiple co-morbidities. Among those
with a single co-morbidity, 100 patients had low risk,
19 patients had moderate risk, and 5 patients had high
risk CAP. For the group with multiple co-morbidities,
135 patients had low risk, 58 patients had moderate risk,
and 20 patients had high risk CAP. This study found
that the presence and number of co-morbidities present
in a patient affected the severity of CAP. Co-morbidities
like diabetes mellitus, hypertension and asthma had
significant correlation to the severity of CAP in patients.
The gender of the patient had no significant correlation
to the severity of CAP.
Conclusion: The presence and number of co-morbidities
present in a patient increases the severity of CAP.
Hypertension, diabetes mellitus, and asthma are comorbidities
that are prerequisites for increased caution
and alert when judging the severity of CAP in patients.
Comparison of patients with single and multiple comorbidities
showed that patients in the latter group
present with higher severity scores (p-value = 0.004).
- Full text:P020150528312547332396.pdf
