Associations between comorbidity-related functional limitations and pneumonia outcomes.

TitleAssociations between comorbidity-related functional limitations and pneumonia outcomes.
Publication TypeJournal Article
Year of Publication2022
AuthorsGreene C, Nian H, Zhu Y, Anthony J, Freundlich KL, Ampofo K, Sartori LF, Johnson J, Arnold DH, Gesteland P, Stassun J, Robison J, Pavia AT, Grijalva CG, Williams DJ
JournalJ Hosp Med
Date Published2022 Jun 27
ISSN1553-5606
Abstract

BACKGROUND: Underlying comorbidities are common in children with pneumonia.

OBJECTIVE: To determine associations between comorbidity-related functional limitations and risk for severe pneumonia outcomes.

DESIGN, SETTING, AND PARTICIPANTS: We prospectively enrolled children <18 years with and without comorbidities presenting to the emergency department with clinical and radiographic pneumonia at two institutions. Comorbidities included chronic conditions requiring daily medications, frequent healthcare visits, or which limited age-appropriate activities. Among children with comorbidities, functional limitations were defined as none or mild, moderate, and severe.

MAIN OUTCOMES AND MEASURES: Outcomes included an ordinal severity outcome, categorized as very severe (mechanical ventilation, shock, or death), severe (intensive care without very severe features), moderate (hospitalization without severe features), or mild (discharged home), and length of stay (LOS). Multivariable ordinal logistic regression was used to examine associations between comorbidity-related functional limitations and outcomes, while accounting for relevant covariates.

RESULTS: A cohort of 1116 children, including 452 (40.5%) with comorbidities; 200 (44.2%) had none or mild functional limitations, 93 (20.6%) moderate, and 159 (35.2%) had severe limitations. In multivariable analysis, comorbidity-related functional limitations were associated with the ordinal severity outcome and LOS (p < .001 for both). Children with severe functional limitations had tripling of the odds of a more severe ordinal (adjusted odds ratio [aOR]: 3.01, 95% confidence interval [2.05, 4.43]) and quadrupling of the odds for longer LOS (aOR: 4.72 [3.33, 6.70]) as compared to children without comorbidities.

CONCLUSION: Comorbidity-related functional limitations are important predictors of disease outcomes in children with pneumonia. Consideration of functional limitations, rather than the presence of comorbidity alone, is critical when assessing risk of severe outcomes.

DOI10.1002/jhm.12904
Alternate JournalJ Hosp Med
PubMed ID35761790
Grant ListUL1 TR002243 / TR / NCATS NIH HHS / United States
R01AI125642 / / National Institute of Allergy and Infectious Diseases /