Associations between comorbidity‐related functional limitations and pneumonia outcomes

作者：Chastity Greene, Hui Nian, Yuwei Zhu, James W. Antoon, Katherine L. Freundlich, Krow Ampofo, Laura F. Sartori, Jakobi A. Johnson, Donald H. Arnold, Per Hans Gesteland, Justine C. Stassun, Jeff A. Robison, Andrew T. Pavia, Carlos Gabriel Grijalva, Derek J. Williams · 发表于：Journal of Hospital Medicine · 年份：2022 · DOI：10.1002/jhm.12904 · 被引用次数：6 · 研究领域：Sepsis Diagnosis and Treatment、Chronic Disease Management Strategies、Pneumonia and Respiratory Infections

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). Chi...