Immune risk phenotype and long-term mortality after community-acquired pneumonia in older adults: clinical and immune determinants
Clotet-Vidal, Sandra (Universitat Autònoma de Barcelona. Departament de Medicina)
Franco Leyva, Teresa (Universitat Autònoma de Barcelona. Departament de Biologia Cel·lular, de Fisiologia i d'Immunologia)
Saez Prieto, M. Encarna (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
Feltrer Martinez, Laura (Universitat Autònoma de Barcelona. Departament de Medicina)
Izquierdo Cardenas, Luis Alvaro (Universitat Autònoma de Barcelona. Departament de Medicina)
Martinez Martinez, Laura (Institut de Recerca Sant Pau)
Casademont i Pou, Jordi (Universitat Autònoma de Barcelona. Departament de Medicina)
Torres Bonafonte, Olga H. (Universitat Autònoma de Barcelona. Departament de Medicina)

Date:	2026
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.
Grants:	Instituto de Salud Carlos III PI18/00684
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Immunosenescence ; Older Adults ; Community-Acquired Pneumonia ; Prognosis
Published in:	Immunity and Ageing, June 2026, ISSN 1742-4933

DOI: 10.1186/s12979-026-00574-8

34 p, 831.8 KB

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Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut de Recerca Sant Pau
Articles > Research articles
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