The effect of immunosuppression on outcomes in elderly patients with community-acquired pneumonia
Abstract Background The effect of immunosuppression on clinical manifestations and outcomes was unclear in elderly patients with CAP. Methods Elderly hospitalised patients with CAP were consecutively enrolled and were divided into immunocompromised hosts (ICHs) or non-ICHs groups. Clinical manifesta...
Saved in:
| Main Authors: | , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-01-01
|
| Series: | Respiratory Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12931-024-03080-x |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832585416775041024 |
|---|---|
| author | Lixue Huang Bingxuan Weng Yuanqi Wang Mengyuan Wang Yin Mei Wei Chen Meng Ma Jingnan Li Jianzhen Weng Yang Ju Xuefeng Zhong Xunliang Tong Yanming Li |
| author_facet | Lixue Huang Bingxuan Weng Yuanqi Wang Mengyuan Wang Yin Mei Wei Chen Meng Ma Jingnan Li Jianzhen Weng Yang Ju Xuefeng Zhong Xunliang Tong Yanming Li |
| author_sort | Lixue Huang |
| collection | DOAJ |
| description | Abstract Background The effect of immunosuppression on clinical manifestations and outcomes was unclear in elderly patients with CAP. Methods Elderly hospitalised patients with CAP were consecutively enrolled and were divided into immunocompromised hosts (ICHs) or non-ICHs groups. Clinical manifestations, severity, and outcomes were compared. The logistic regression model was used to determine the association between immunosuppression and outcomes. The primary outcome was 30-day mortality. Results A total of 822 patients were enrolled, of whom 133 (16.2%) were immunocompromised. There were no differences between the two groups in vital signs, oxygenation, admission laboratory tests, need for mechanical ventilation and intensive care unit admission, except for a lower lymphocyte count in the ICH group (0.9*10^9/L, IQR 0.6–1.3*10^9/L [ICH group] vs. 1.2*10^9/L, IQR 0.8–1.7*10^9/L [non-ICH group]; p < 0.001). The 30-day mortality in ICHs was 15.8%, significantly higher than the 5.1% in non-ICHs (p < 0.001). The risk distribution of severity was similar between the two groups when assessed by CURB-65 on admission; however, the significant difference was found when assessed by PSI. Notably, in the CURB-65 low-risk group, the 30-day mortality was significantly higher in ICHs than in non-ICHs (9.7% vs. 1.1%, p < 0.001); but there was no difference between ICHs and non-ICHs in PSI low-risk group (3.7% vs. 0.6%; p > 0.05). After adjusting for age, sex, and comorbidities, immunosuppression was significantly associated with a higher risk of 30-day mortality (odds ratio 5.004, 95% CI [2.618–9.530]). Conclusions Immunosuppression was independently associated with an increased risk of 30-day mortality. CURB-65 may underestimate the mortality risk of ICHs. |
| format | Article |
| id | doaj-art-4281628fce154d9fb6f0084d8e515cc2 |
| institution | Kabale University |
| issn | 1465-993X |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Respiratory Research |
| spelling | doaj-art-4281628fce154d9fb6f0084d8e515cc22025-01-26T12:49:00ZengBMCRespiratory Research1465-993X2025-01-012611810.1186/s12931-024-03080-xThe effect of immunosuppression on outcomes in elderly patients with community-acquired pneumoniaLixue Huang0Bingxuan Weng1Yuanqi Wang2Mengyuan Wang3Yin Mei4Wei Chen5Meng Ma6Jingnan Li7Jianzhen Weng8Yang Ju9Xuefeng Zhong10Xunliang Tong11Yanming Li12Department of Pulmonary and Critical Care Medicine, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical ScienceDepartment of Pulmonary and Critical Care Medicine, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical ScienceDepartment of Pulmonary and Critical Care Medicine, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical ScienceDepartment of Pulmonary and Critical Care Medicine, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical ScienceDepartment of Pulmonary and Critical Care Medicine, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical ScienceDepartment of Pulmonary and Critical Care Medicine, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical ScienceDepartment of Pulmonary and Critical Care Medicine, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical ScienceDepartment of Pulmonary and Critical Care Medicine, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical ScienceDepartment of Pulmonary and Critical Care Medicine, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical ScienceDepartment of Pulmonary and Critical Care Medicine, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical ScienceDepartment of Pulmonary and Critical Care Medicine, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical ScienceDepartment of Pulmonary and Critical Care Medicine, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical ScienceDepartment of Pulmonary and Critical Care Medicine, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical ScienceAbstract Background The effect of immunosuppression on clinical manifestations and outcomes was unclear in elderly patients with CAP. Methods Elderly hospitalised patients with CAP were consecutively enrolled and were divided into immunocompromised hosts (ICHs) or non-ICHs groups. Clinical manifestations, severity, and outcomes were compared. The logistic regression model was used to determine the association between immunosuppression and outcomes. The primary outcome was 30-day mortality. Results A total of 822 patients were enrolled, of whom 133 (16.2%) were immunocompromised. There were no differences between the two groups in vital signs, oxygenation, admission laboratory tests, need for mechanical ventilation and intensive care unit admission, except for a lower lymphocyte count in the ICH group (0.9*10^9/L, IQR 0.6–1.3*10^9/L [ICH group] vs. 1.2*10^9/L, IQR 0.8–1.7*10^9/L [non-ICH group]; p < 0.001). The 30-day mortality in ICHs was 15.8%, significantly higher than the 5.1% in non-ICHs (p < 0.001). The risk distribution of severity was similar between the two groups when assessed by CURB-65 on admission; however, the significant difference was found when assessed by PSI. Notably, in the CURB-65 low-risk group, the 30-day mortality was significantly higher in ICHs than in non-ICHs (9.7% vs. 1.1%, p < 0.001); but there was no difference between ICHs and non-ICHs in PSI low-risk group (3.7% vs. 0.6%; p > 0.05). After adjusting for age, sex, and comorbidities, immunosuppression was significantly associated with a higher risk of 30-day mortality (odds ratio 5.004, 95% CI [2.618–9.530]). Conclusions Immunosuppression was independently associated with an increased risk of 30-day mortality. CURB-65 may underestimate the mortality risk of ICHs.https://doi.org/10.1186/s12931-024-03080-xCommunity-acquired pneumoniaImmunocompromisedElderlyOutcomes |
| spellingShingle | Lixue Huang Bingxuan Weng Yuanqi Wang Mengyuan Wang Yin Mei Wei Chen Meng Ma Jingnan Li Jianzhen Weng Yang Ju Xuefeng Zhong Xunliang Tong Yanming Li The effect of immunosuppression on outcomes in elderly patients with community-acquired pneumonia Respiratory Research Community-acquired pneumonia Immunocompromised Elderly Outcomes |
| title | The effect of immunosuppression on outcomes in elderly patients with community-acquired pneumonia |
| title_full | The effect of immunosuppression on outcomes in elderly patients with community-acquired pneumonia |
| title_fullStr | The effect of immunosuppression on outcomes in elderly patients with community-acquired pneumonia |
| title_full_unstemmed | The effect of immunosuppression on outcomes in elderly patients with community-acquired pneumonia |
| title_short | The effect of immunosuppression on outcomes in elderly patients with community-acquired pneumonia |
| title_sort | effect of immunosuppression on outcomes in elderly patients with community acquired pneumonia |
| topic | Community-acquired pneumonia Immunocompromised Elderly Outcomes |
| url | https://doi.org/10.1186/s12931-024-03080-x |
| work_keys_str_mv | AT lixuehuang theeffectofimmunosuppressiononoutcomesinelderlypatientswithcommunityacquiredpneumonia AT bingxuanweng theeffectofimmunosuppressiononoutcomesinelderlypatientswithcommunityacquiredpneumonia AT yuanqiwang theeffectofimmunosuppressiononoutcomesinelderlypatientswithcommunityacquiredpneumonia AT mengyuanwang theeffectofimmunosuppressiononoutcomesinelderlypatientswithcommunityacquiredpneumonia AT yinmei theeffectofimmunosuppressiononoutcomesinelderlypatientswithcommunityacquiredpneumonia AT weichen theeffectofimmunosuppressiononoutcomesinelderlypatientswithcommunityacquiredpneumonia AT mengma theeffectofimmunosuppressiononoutcomesinelderlypatientswithcommunityacquiredpneumonia AT jingnanli theeffectofimmunosuppressiononoutcomesinelderlypatientswithcommunityacquiredpneumonia AT jianzhenweng theeffectofimmunosuppressiononoutcomesinelderlypatientswithcommunityacquiredpneumonia AT yangju theeffectofimmunosuppressiononoutcomesinelderlypatientswithcommunityacquiredpneumonia AT xuefengzhong theeffectofimmunosuppressiononoutcomesinelderlypatientswithcommunityacquiredpneumonia AT xunliangtong theeffectofimmunosuppressiononoutcomesinelderlypatientswithcommunityacquiredpneumonia AT yanmingli theeffectofimmunosuppressiononoutcomesinelderlypatientswithcommunityacquiredpneumonia AT lixuehuang effectofimmunosuppressiononoutcomesinelderlypatientswithcommunityacquiredpneumonia AT bingxuanweng effectofimmunosuppressiononoutcomesinelderlypatientswithcommunityacquiredpneumonia AT yuanqiwang effectofimmunosuppressiononoutcomesinelderlypatientswithcommunityacquiredpneumonia AT mengyuanwang effectofimmunosuppressiononoutcomesinelderlypatientswithcommunityacquiredpneumonia AT yinmei effectofimmunosuppressiononoutcomesinelderlypatientswithcommunityacquiredpneumonia AT weichen effectofimmunosuppressiononoutcomesinelderlypatientswithcommunityacquiredpneumonia AT mengma effectofimmunosuppressiononoutcomesinelderlypatientswithcommunityacquiredpneumonia AT jingnanli effectofimmunosuppressiononoutcomesinelderlypatientswithcommunityacquiredpneumonia AT jianzhenweng effectofimmunosuppressiononoutcomesinelderlypatientswithcommunityacquiredpneumonia AT yangju effectofimmunosuppressiononoutcomesinelderlypatientswithcommunityacquiredpneumonia AT xuefengzhong effectofimmunosuppressiononoutcomesinelderlypatientswithcommunityacquiredpneumonia AT xunliangtong effectofimmunosuppressiononoutcomesinelderlypatientswithcommunityacquiredpneumonia AT yanmingli effectofimmunosuppressiononoutcomesinelderlypatientswithcommunityacquiredpneumonia |