Immunophenotype of Risk in Older Patients Admitted for Pneumonia

Study Overview
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Brief Summary
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The objective is to evaluate if the immune risk phenotype (IRP) in patients who have been admitted for pneumonia predisposes to worse long-term outcomes. In addition, the association between the detected immunological alterations and clinical, functional, nutritional or comorbidity risk factors will be evaluated. If the hypothesis is confirmed, helpful immunological markers will be identified. This will be useful in clinical practice to identify patients who can benefit from an intervention and / or to identify the best time for vaccination. Otherwise, valuable information will be obtained on the interrelation between immunological, clinical, functional and nutritional aspects.

Detailed Description
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The objective is to evaluate if the immune risk phenotype (IRP) in patients who have been admitted for pneumonia predisposes to worse long-term outcomes. In addition, the association between the detected immunological alterations and clinical, functional, nutritional or comorbidity risk factors will be evaluated. Methodology: Prospective observational study. It will include 149 patients ≥ 65 years admitted for pneumonia. After 30-45 days of pneumonia diagnosis, a complete clinical, functional, nutritional and immunological assessment will be carried out. FRI will be defined as a positive cytomegalovirus serology together with at least one of the following: CD4 / CD8 <1, CD8 T cells> 600 / μl or negative CD28 T cells> 300 / μl15. Mortality and re-admissions at 12 and 18 months will be evaluated. If the hypothesis is confirmed, helpful immunological markers will be identified. This will be useful in clinical practice to identify patients who can benefit from an intervention and / or to identify the best time for vaccination. Otherwise, valuable information will be obtained on the interrelation between immunological, clinical, functional and nutritional aspects.

Official Title
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Identification of an Immunophenotype of Risk of Poor Prognosis in Elderly Patients Who Have Been Admitted for Pneumonia

Conditions
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Pneumonia, Age Associated Immune Deficiency, Elderly Infection, Nutrition Disorders in Old Age, Frail Elderly Syndrome, Sarcopenia

Intervention / Treatment
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* Other: no intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: patients ≥ 65 years old admitted for pneumonia in the Hospital de la Santa Creu i Sant Pau in Barcelona. Exclusion Criteria: patients from another acute care hospital patients with HIV infection neutropenic patients (neutrophil count <1000 / mm3) transplant patients patients in end-of-life situation not having written informed consent.

Ages Eligible for Study
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Minimum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Study cohort<br> | Other: no intervention<br>* It is an observationa study. There is no intervention.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Presence of the immune risk phenotype (IRP) | To assess whether the presence of the immune risk phenotype (IRP) in patients who have been admitted for pneumonia predisposes to higher mortality after 18 months of pneumonia. | 18 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of readmissions | To assess number of readmissions at 18 months. | 18 months | 
| Immunological markers other than IRP | To evaluate if immunological markers other than IRP predispose to higher mortality or readmission rates | 18 months | 
| Immunological profile | To describe the basic immunological profile of the elderly who have been admitted due to pneumonia and its evolution after the acute phase. | 18 months | 
| Immunological alterations | To study if there is an association between IRP and clinical, functional, nutritional, comorbidity risk factors or frailty/sarcopenia. | 18 months |