Clinical aspects and prognostic factors in elderly patients hospitalised for community-acquired pneumonia

• Published in: European journal of clinical microbiology & infectious diseases 2001-01, Vol.20 (1), p.14-19
• Main Authors: GARCIA-ORDONEZ, M. A, GARCIA-JIMENEZ, J. M, PAEZ, F, ALVAREZ, F, POYATO, B, FRANQUELO, M, COLMENERO, J. D, JUAREZ, C
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Bacterial diseases; Bacterial diseases of the respiratory system; Biological and medical sciences; Chlamydia; Community-Acquired Infections - epidemiology; Community-Acquired Infections - mortality; Comorbidity; Etiology; Female; Hospitalization; Human bacterial diseases; Humans; Incidence; Infectious diseases; Lavage; Male; Medical sciences; Mortality; Multivariate Analysis; Older people; Pneumonia; Pneumonia, Bacterial - blood; Pneumonia, Bacterial - epidemiology; Pneumonia, Bacterial - mortality; Pneumonia, Bacterial - physiopathology; Prediction models; Predictive Value of Tests; Prognosis; Risk Factors; Serology; Spain - epidemiology; Survival Analysis; Urea
• ISSN: 0934-9723; 1435-4373
• DOI: 10.1007/s100960000413

The aims of this study were to determine the clinical and epidemiological characteristics of community-acquired pneumonia (CAP) in the elderly, to identify prognostic factors, and to establish a predictive model for mortality of CAP. Elderly patients with CAP admitted to "Carlos Haya" Hospital in Malaga, Spain, over a 36-month period were included. Multivariate analysis was used to identify prognostic factors from variables present on admission, from which a discrimination rule was constructed to predict mortality. A total of 343 patients were included, with the annual incidence ranging from 16.3 to 28.1 per 1,000 admissions. Most (82.5%) had some kind of accompanying or underlying disease. Clinical presentation was atypical in 87 (25.4%). Microbiological diagnosis was made in 24.5%. There were 49 (14.3%) deaths. The prognostic factors in multivariate analysis on admission were bilateral radiographic infiltrate, a blood urea nitrogen level of more than 7 mmol/l, absence of fever, a respiratory rate of 30/min or more, confusion, and shock. The discriminating rule to predict mortality comprising three or more of these factors was 91.2% specific, with a negative predictive value of 93.4% and an overall accuracy of 86.9%. CAP in the elderly is associated with a high degree of mortality. The discriminating rule incorporating the prognostic factors identified is a powerful predictor of mortality.