Pneumonia risks in bedridden patients receiving oral care and their screening tool: Malnutrition and urinary tract infection-induced inflammation

Aim: Pneumonia develops in bedridden patients even when they are receiving oral care. However, the pneumonia risk in bedridden patients remains unclear, and no screening tool has been developed to assess this risk by using daily hospital data. Methods: We retrospectively examined pneumonia risk factors by analyzing the records of 102 bedridden patients receiving oral care. Results: Body mass index, peripheral blood hemoglobin, and serum concentrations of total protein, albumin, total cholesterol and uric acid in the pneumonia group (n = 51; mean age 73.4 years) were lower than those in the non-pneumonia group (n = 51; mean age 68.1 years). In the univariate analysis, body mass index; leukocytosis; high C-reactive protein; low levels of hemoglobin, total protein and albumin (<3.5 g/dL); and urine bacteria were associated with the development of pneumonia. Furthermore, in the multivariate analysis, low levels of albumin and urine bacteria were independently associated with pneumonia. We developed a bedridden patient pneumonia risk (BPPR) score using these two risk factors to assess pneumonia risk. We applied scores of zero (0) or one (1) according to the absence or presence of the two risk factors and summed the scores in each patient. The proportion of pneumonia patients increased with increasing BPPR score when the patients were divided into three groups – low, moderate and high risk – according to the BPPR score (0, 1 or 2, respectively). Conclusions: Malnutrition, urinary tract infection-induced inflammation and anemia were associated with pneumonia in bedridden patients. BPPR scoring might be useful for assessing pneumonia risk and managing affected patients. Geriatr Gerontol Int 2018; 18: 714–722.