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Objectives <p>To describe the age-stratified clinical characteristics, ICU management, and in-hospital outcomes of adults admitted to Japanese ICUs with aspiration pneumonia.</p> Design <p>Multicenter, retrospective, observational cohort study.</p> Setting <p>Multiple ICUs participated in the Japanese Intensive Care Patient Database (JIPAD), a nationwide registry of the Japanese Society of Intensive Care Medicine, from 2015 to 2023.</p> Patients <p>Adults ≥ 18&#xa0;years admitted to ICUs with a primary diagnosis of aspiration pneumonia.</p> Measurements and main results <p>Among 3,906 eligible ICU admissions (median age, 76&#xa0;years [IQR, 68–83]; 75.5% male), illness severity at admission increased with age (median APACHE III score, 74 [56–91] in patients aged 18–64&#xa0;years vs. 96 [81–120] in those aged ≥ 85&#xa0;years). Invasive mechanical ventilation (MV) was used in 68.8% of patients and was less frequent in older age groups (18–64&#xa0;years: 73.2%; 65–74&#xa0;years: 74.2%; 75–84&#xa0;years: 69.9%; ≥ 85&#xa0;years: 55.4%). Overall in-hospital mortality was 28.3% and increased across age groups (18–64&#xa0;years: 13.7%; 65–74&#xa0;years: 25.0%; 75–84&#xa0;years: 32.1%; ≥ 85&#xa0;years: 39.3%). Median hospital and ICU lengths of stay were 32&#xa0;days (IQR, 16–58) and 120.4&#xa0;h (IQR, 54.4–234.8), respectively. In-hospital pathways differed markedly across age groups: among patients aged ≥ 85&#xa0;years, in-hospital mortality reached 39.3%, and home discharge was achieved in only 19.9%, compared with 13.7% and 45.2% among patients aged 18–64&#xa0;years, respectively. In the exploratory adjusted analyses, the probability of in-hospital mortality increased with age, whereas that of MV use decreased, particularly in patients aged &gt; 75&#xa0;years.</p> Conclusions <p>Older patients with aspiration pneumonia had higher illness severity yet received less MV, and had higher in-hospital mortality and lower home discharge rates. These nationwide data describe the current state of ICU-managed aspiration pneumonia in a super-aged society and may provide a reference point for future comparative studies.</p>

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Aspiration pneumonia in the world's most aged society: age-stratified ICU management and outcomes from a nationwide Japanese registry

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  • 发表日期：

    2026年8月1日

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  • Satoru Sekiya,
  • Shunsaku Goto,
  • Hiromu Okano,
  • Hiroshi Okamoto

摘要

Objectives

To describe the age-stratified clinical characteristics, ICU management, and in-hospital outcomes of adults admitted to Japanese ICUs with aspiration pneumonia.

Design

Multicenter, retrospective, observational cohort study.

Setting

Multiple ICUs participated in the Japanese Intensive Care Patient Database (JIPAD), a nationwide registry of the Japanese Society of Intensive Care Medicine, from 2015 to 2023.

Patients

Adults ≥ 18 years admitted to ICUs with a primary diagnosis of aspiration pneumonia.

Measurements and main results

Among 3,906 eligible ICU admissions (median age, 76 years [IQR, 68–83]; 75.5% male), illness severity at admission increased with age (median APACHE III score, 74 [56–91] in patients aged 18–64 years vs. 96 [81–120] in those aged ≥ 85 years). Invasive mechanical ventilation (MV) was used in 68.8% of patients and was less frequent in older age groups (18–64 years: 73.2%; 65–74 years: 74.2%; 75–84 years: 69.9%; ≥ 85 years: 55.4%). Overall in-hospital mortality was 28.3% and increased across age groups (18–64 years: 13.7%; 65–74 years: 25.0%; 75–84 years: 32.1%; ≥ 85 years: 39.3%). Median hospital and ICU lengths of stay were 32 days (IQR, 16–58) and 120.4 h (IQR, 54.4–234.8), respectively. In-hospital pathways differed markedly across age groups: among patients aged ≥ 85 years, in-hospital mortality reached 39.3%, and home discharge was achieved in only 19.9%, compared with 13.7% and 45.2% among patients aged 18–64 years, respectively. In the exploratory adjusted analyses, the probability of in-hospital mortality increased with age, whereas that of MV use decreased, particularly in patients aged > 75 years.

Conclusions

Older patients with aspiration pneumonia had higher illness severity yet received less MV, and had higher in-hospital mortality and lower home discharge rates. These nationwide data describe the current state of ICU-managed aspiration pneumonia in a super-aged society and may provide a reference point for future comparative studies.