Community‐Acquired Pneumonia in Older Veterans: Does the Pneumonia Prognosis Index Help?

Abstract

OBJECTIVES: Mortality rates from pneumonia increase steadily with age. Recently, a disease severity model (the Pneumonia Prognosis Index (PPI)) has been developed to predict mortality from community‐acquired pneumonia (CAP). PPI ranks severity of pneumonia from 1 to 5, with 5 being most severe. This retrospective study utilizes the PPI to address the prognosis of CAP in older adults. DESIGN: Retrospective review of medical charts. SETTING: Department of Veterans Affairs Medical Center. PARTICIPANTS: All adults aged 60 and older admitted to a Veterans Affairs Medical Center with CAP between January 1 and December 31, 1998. MEASUREMENTS: PPI was calculated using subjects' demographics, comorbidities, presenting symptoms, and laboratory measurements. RESULTS: Eighty‐two patients aged 60 and older were admitted with 101 episodes of CAP. The mean age ± standard deviation was 72 ± 9. Seventy‐four episodes were admitted from the emergency room, 20 from another hospital, seven from nursing homes, and five from outpatient clinics. Mean length of stay was 7.1 ± 6 days. Comorbid conditions included coronary artery disease, diabetes mellitus, congestive heart failure, neoplasm, stroke, and renal failure. Most episodes fell into higher PPI classes, with 20% in Class 3, 46% in Class 4, and 32% in Class 5. PPI score was significantly related to length of stay (P < .001), intensity of care (P < .0001), and presence of complications (P < .001). Mortality was 14% at 30 days: 0.5% in Class 3, 10.8% in Class 4, and 25% in Class 5. CONCLUSION: The PPI was effective in identifying older adults with CAP who were at risk of a poor outcome, but the practical utility of this index remains to be determined. Further prospective studies are required to elucidate the importance of comorbidities, severity at presentation, and premorbid functional status on clinical and functional outcomes of CAP in older adults. J Am Geriatr Soc 50:434–438, 2002.

Comparison of clinical characteristics and performance of pneumonia severity score and CURB-65 among younger adults, elderly and very old subjects

“…Our results corroborate this finding by showing a decreasing discriminative power (measured by AUC) of PSI and CURB-65 with advancing age categories 19 20 27–29. An obvious reason for the underperformance of the PSI in elderly patients is the undue weights given to the age variable in the PSI score.…”

“…It has been shown that the established scoring systems for CAP severity may not perform well in elderly patients because their atypical clinical presentations may make the cut-off values for the scoring system unreliable 19 20. Our results corroborate this finding by showing a decreasing discriminative power (measured by AUC) of PSI and CURB-65 with advancing age categories 19 20 27–29.…”

Prognostic factors for mortality due to pneumonia among adults from different age groups in Singapore and mortality predictions based on PSI and CURB-65

“…Underestimation of the risk of death with increasing age has often been reported. (24)(25)(26) Pneumonia represents a significant healthcare issue in Singapore. It is the fifth most common cause of hospitalisation and the second principal cause of death.…”

Frequency and relevance of concomitant diseases in elderly patients hospitalized for community acquired pneumonia

“…Zna èaj kar di o va sku lar nih bo le sti, kao fak to ra lo še progno ze VSP, is ti èu mno gi auto ri. Ko ro nar na ar te rijska bo lest i kon ge stiv no ošte aee we sr ca su èe sta pridru že na sta wa kod sta ri jih oso ba sa VSP ko ja mo gu da uka žu na mo gu aeu smrt bo le sni ka [18]. U na šem istra ži va wu smrt nost i bo le sni ka mla ðih i bo le snika sta ri jih od 65 go di na bi la je sta ti stiè ki zna èajno ve aea kod is pi ta ni ka sa de kom pen zo va nom kar di omi o pa ti jom ne go kod onih kod ko jih ovo obo qe we nije di jag no sti ko va no.…”

“…Ci ro za je tre je po tvr ðe ni fak tor ri zi ka is hoda pne u mo ni ja, dok je smrt nost od pne u mo kok ne pne umo ni je ve aea kod oso ba obo le lih od ci ro ze je tre [19]. Mno gi auto ri na vo de ne u ro lo ška obo qe wa, po put možda nog uda ra i ma lig ne bo le sti, kao èe sta obo qe wa kod sta ri jih oso ba sa VSP i fak to re ri zi ka u predvi ða wu smrt nog is ho da usled VSP [18], ali to na šim is tra ži va wem ni je po tvr ðe no.…”