Early Sitting Improves the Accuracy of Predicting In-Hospital Mortality in Older Adult Patients With Pneumonia

TL;DR

Early sitting by physical therapists improves the accuracy of predicting in-hospital mortality for older adults with pneumonia.

Contribution

This study shows that early sitting significantly enhances mortality prediction models for elderly pneumonia patients.

Findings

Early sitting was a strong predictor of in-hospital mortality across all four logistic regression models.

Adding early sitting to the models increased the area under the curve (AUC), indicating better predictive accuracy.

All models showed statistically significant improvements in AUC when early sitting was included.

Abstract

Introduction

Older adult patients with pneumonia have high in-hospital mortality rates, and their clinical course is complex and varied. Consequently, determining whether to prioritize early mobilization or palliative care by physical therapists is challenging. Therefore, this study aimed to investigate whether early sitting increases the accuracy of predicting in-hospital mortality among older adult patients with pneumonia.

Methodology

This was a single-center retrospective cohort study. We included patients aged ≥65 years who were hospitalized with pneumonia. Early sitting was defined as Intensive Care Unit Mobility Scale (IMS) category 3 within a week of admission. Four multiple logistic regression models were constructed to evaluate the influence of early sitting or not as a predictor of in-hospital mortality, with factors at admission based on a literature review. To evaluate the contribution of early sitting to the discriminatory performance of each logistic regression model, we compared the area under the curve (AUC) of each model with and without the inclusion of this variable using DeLong’s test for correlated receiver operating characteristic (ROC) curves.

Results

Of the 348 patients, 47 (13.5%) and 301 (86.5%) were nonsurvivors and survivors, respectively. All models identified early sitting as a predictor of in-hospital mortality (model 1: odds ratio [OR] = 0.09, 95% confidence interval [CI], 0.04-0.22, P < 0.001; model 2: OR = 0.06, 95% CI, 0.02-0.13, P < 0.001; model 3: OR = 0.07, 95% CI, 0.03-0.15, P < 0.001; model 4: OR = 0.06, 95% CI, 0.03-0.14, P < 0.001). The AUC increased in all models when early sitting was added as a factor compared with and without that (AUC of model 1, 0.819 vs. 0.874, P = 0.005; model 2, 0.713 vs. 0.831, P < 0.001; model 3, 0.733 vs. 0.820, P < 0.001; model 4, 0.709 vs. 0.817, P < 0.001).

Conclusions

It is suggested that the addition of early sitting by a physical therapist as a post-hospitalization process to the previously reported in-hospital mortality factors for older adult patients with pneumonia may improve their predictive accuracy.

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