Abstract Background Community-acquired pneumonia (CAP) has been associated with poor long-term outcomes in older adults. In most pre-pandemic studies, long-term mortality was assessed with a focus on comorbidity burden. Although immunosenescence is a key determinant of CAP, post-acute immune patterns have been little explored. Objective To assess 18-month mortality after CAP hospitalisation and the prognostic value of the Immune Risk Phenotype (IRP). Methods Prospective, observational study of adults ≥ age 65 years discharged after CAP (2019—21). We performed comprehensive geriatric and nutritional assessments, including laboratory tests at 30–60 days post diagnosis. IRP was defined as cytomegalovirus seropositivity with inverted CD4:CD8 ratio, elevated CD8 + T cell count, or expansion of CD8CD28-T cells. The main outcome measure was 18-month mortality. Multivariate logistic with ROC curves and Cox regression analyses were performed. (ClinicalTrials.gov, NCT0462799). Results The sample included 143 patients (55.2% males), with a mean age of 77.6 ± 7.9 years. IRP was found in 46.8% of patients. Elevated lymphocyte count and female sex were predictors of IRP. At 18 months post-CAP, 27 patients (18%) had died, mainly due to infections ( n = 13, 48%) and fractures ( n = 2, 7.4%). Predictors of 18-month mortality included IRP (HR 2.58 95% CI 1.11–5.99; p = 0.027), severe chronic kidney disease (6.16 2.53–14.99; p <0.001), poor functional status (3.69 1.53–8.90 p = 0.004), and hypoalbuminemia (3.35; 1.34–8.41; p = 0.010). Conclusions This study underscores the role of infectious complications in long-term outcomes after CAP. These findings highlight the need for comprehensive geriatric assessment to identify multidimensional risk factors, including immunosenescence as a potentially modifiable domain warranting further investigation and integration into care.
Clotet et al. (Tue,) studied this question.