Defining prognostic factors in the elderly with community acquired pneumonia: a case controlled study of patients aged ≥75 yrs

Abstract

Defining prognostic factors in the elderly with community acquired pneumonia: a case controlled study of patients aged ¢75 yrs. W.-S. Lim, J.T. Macfarlane. #ERS Journals Ltd 2001. ABSTRACT: Severity assessment in the elderly with community acquired pneumonia (CAP) may be different compared with younger patients. In particular, age per se may not be of prognostic significance in older patients. A case-control study in 158 patients aged ¢75 yrs with CAP was conducted to determine the factors associated with in-hospital mortality.Cases were drawn from all patients aged ¢75 yrs with CAP who died in 1997 in five hospitals in the mid-Trent region of the UK (Nottingham City Hospital, University Hospital Nottingham, Derby Royal Infirmary, Derby City General Hospital and Kings Hill Hospital). Controls were randomly selected from survivors also aged ¢75 yrs. Factors associated with mortality were identified following a review of the medical casenotes and the contribution of these factors to mortality was determined using multivariate analysis.Absence of fever, tachycardia and chest radiograph features of bilateral involvement or an effusion were independently associated with mortality on multivariate analysis. The British Thoracic Society (BTS) severity rule was 50% sensitive and 64% specific in predicting death while the modified BTS rule displayed 67% sensitivity and 58% specificity.Age was not significantly associated with mortality in this group of patients aged ¢75 yrs. Similarly, the clinical features employed in the British Thoracic Society rule, namely respiratory rate, diastolic blood pressure and blood urea, were not of prognostic significance and the rule itself performed poorly. The modified British Thoracic Society rule performed better.

A Study of Community-Acquired Pneumonias in Elderly Individuals in Bijapur, India

“…The hepatic impairment and the impaired renal function were more severe in the elderly age group compared to the younger groups in various studies. This may suggest a more severe systemic infection in this age group [21]. Hyponatremia was seen in 8 (16%) of patients.…”

A prospective comparison of severity scores for identifying patients with severe community acquired pneumonia: reconsidering what is meant by severe pneumonia

“…This tool has been validated independently. [13][14][15] N The CURB-65 index 7 is a further modification of the BTS prediction rules. Age >65 years is added as a fifth variable to the four core variables mentioned above.…”

Prognosis of primary care patients aged 80 years and older with lower respiratory tract infection

“…Other studies examining prognostic factors of pneumonia or LRTIs have identified several clinical predictor variables, such as confusion, respiratory rate, temperature, and blood pressure. 7,8,[11][12][13]16,17,24 Future studies should use a prospective design and also take clinical data into account. While these studies are not available yet, the authors believe that the present results are very useful for GPs.…”

“…[7][8][9][10][11][12][14][15][16][17]21,22,[24][25][26] Age, sex, current use of medication, comorbidity, and healthcare use in the previous 12 months, including hospitalisation and GP visits, were regarded as potential predictors. Current use of medication was defined as medication prescribed on the day of diagnosis and ≥1 week prior to that day.…”

“…The reasons for this range from exclusively including patients in a hospital setting, [7][8][9][10][11][12][13][14][15][16] to selecting patients with community-acquired pneumonia only. [7][8][9][10][11][12][13][15][16][17][18][19][20] Some studies investigated the aetiological factors and used a case-control design, [15][16][17][18] others tested the validity or usefulness of an existing prediction rule. 10,13 Of note, the number of patients aged ≥80 years in most studies was low, or it was not totally clear how many older patients were included.…”