Pneumonia Twice As Deadly As Hip Fractures in Elderly Patients

Leslie Grammatico Guillon, MD, PhD

Hospitalized elderly patients with pneumonia were twice as likely to die as those with fractures in new research presented at the European Congress of Clinical Microbiology and Infectious Diseases (ECCMID).

The findings suggested that the common yet life-threatening disease should be assessed and recognized as a condition with serious consequences.

Leslie Grammatico-Guillon, MD, PhD, and colleagues used medico-administrative data collected from the French-DRG to change the trivialization of pneumonia in elderly patients and to help the vaccination uptake. The team found that those hospitalized for acute respiratory infection had a more than three-fold greater in-hospital mortality than those with hip fracture.

Grammatico-Guillon, from Francois Rabelais University Medical School in Tours, France, and the team of investigators defined acute respiratory infection and hip fracture using ICD-10 and Current Procedural Terminology algorithms. The team compared two-year outcomes for patients >80 years old after hospitalization for acute respiratory infection or hip fracture.

Overall, 16,917 patients were hospitalized for acute respiratory infection (12,159 patients) or hip fracture (4758 patients).

Those hospitalized for acute respiratory infection had more comorbidities than patients with hip fracture and a greater in-hospital mortality (17.9% mortality for respiratory infection vs 5.4% mortality for hip fracture).

Using the Kaplan-Meier curve, which helped estimate the survival function from lifetime data, the investigators saw a significant difference in mortality for the 2 groups (log rank test, P <.1).

After the investigators adjusted for comorbid conditions, frailty score, age, and sex, the global risk of death at 2 years for those hospitalized for acute respiratory infection was significantly higher (80%) compared to patients hospitalized for hip fracture (HR, 1.8; 95% CI, 1.7-2).

Although pneumonia can be life-threatening, especially in elderly people, many patients fail to accurately gauge their own risk for the infection, which could lead to inadequate prevention efforts and a low uptake of existing vaccines. Study authors suggested that the mismatch between the high risk of disease and death from pneumonia and low awareness of how severe if could be could lead to unhealthy aging.

When it comes to hip fracture, however, it has been widely recognized as a major concern for the elderly patient population—perhaps unnecessarily in comparison to the dangers of pneumonia.

“We hope that placing the consequences of pneumonia in relation to the consequences of a hip fracture may provide useful perspective for discussions of pneumonia and its prevention with aging populations,” Guillon and colleagues wrote.

The aging population, their caregivers, and clinical practitioners should be more aware of the risks of pneumonia.

“Better recognition will improve the prevention of pneumonia by increasing uptake of vaccines, such as influenza and pneumococcus,” the authors concluded.

The study, “If breaking a hip feels like a concern for the elderly, then getting pneumonia should be twice as concerning,” was presented at the European Congress of Clinical Microbiology and Infectious Diseases.