Neumonía adquirida en la comunidad en el anciano inmunocompetente que requiere hospitalización. Cuadro clínico, factores pronósticos y tratamiento

Pneumonia Awareness Year, 2004: Scientific Impact Through Publications in Archivos de Bronconeumología

“…Contrary to common belief, CAP was acute in 63% of the cases and S pneumoniae was the causal agent in 49% of the cases for which a microbiologic diagnosis was available. Mortality, at 11%, was low compared with the crude mortality rate of 20.8% observed in a retrospective study by Clemente et al 40 in 2002 but was similar to the hospital mortality of 10% and the 30-day mortality of 13% observed by Saldías Peñafiel et al 42 Risk factors for poor prognosis identified in the TIR study 102 were as follows: patient previously bedridden, altered mental status, absence of chills, plasma creatinine levels over 1.4 mg/dL, a ratio of PaO 2 to inspired oxygen fraction (FiO) less than 200 upon admission, and kidney failure or shock during the pneumonia episode. Other independent risk factors associated with mortality that have been found are serum creatinine level of 1.2 mg/dL (relative risk [RR], 13.9), bedridden patient (RR, 5.7), PaO 2 /FiO 2 of 200 (RR, 5), and neoplastic disease (RR, 4.1) 40 ; and advanced age (83 years), absence of cough, low blood pressure, and elevated phosphate levels.…”

“…Mortality was higher in residents of geriatric facilities (28%) than in those living in private homes (4.5%), although the rate for home-living patients was lower than that reported from earlier studies. 40,42,102 Urea nitrogen level was the best predictor of mortality in this population. Finally, if CAP in the immunocompetent elderly patient requiring admission is a prevalent disease with particular clinical and epidemiologic characteristics, RAJAS 25 1 Case Report 65, 66 2 Letter to the Editor 84- 86 3 Other Guidelines/Recommendations 88, 89 2 Special Supplement Article 98-100 3 Total 25 course, and prognosis 42 in and of itself, it can also be seen from the analysis of source of transfer prior to admission that cases coming from group residential facilities are particularly severe and such provenance is a major risk factor for death even if the etiologic agents do not differ from the usual ones.…”

“…Other independent risk factors associated with mortality that have been found are serum creatinine level of 1.2 mg/dL (relative risk [RR], 13.9), bedridden patient (RR, 5.7), PaO 2 /FiO 2 of 200 (RR, 5), and neoplastic disease (RR, 4.1) 40 ; and advanced age (83 years), absence of cough, low blood pressure, and elevated phosphate levels. 42 Clemente et al 40 found that the presence of chest pain was associated with a lower risk of death (RR, 0.11).…”

Diseño de un índice pronóstico clínico para el manejo de la neumonía del adulto adquirida en la comunidad

“…En un estudio reciente, se ha comunicado en nuestro medio que el índice pronóstico de Fine (PSI) se correlaciona con el riesgo de muerte y la tasa de complicaciones en el hospital de los pacientes adultos admitidos por NAC, lo que sugiere podría ser una herramienta útil para decidir el lugar donde ellos deben ingresar (Sala, Unidad de Cuidados Intermedios o UCI) 18,19 .…”

“…Luego se procedió a construir una herramienta pronóstica considerando sólo aquellas variables clínico-radiográficas que resultaron significativas en el análisis univariado y que a su vez tuvieran respaldo en la literatura médica [1][2][3][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] , asignándoles un puntaje proporcional a sus valores de odds ratio. Finalmente, los pacientes fueron agrupados en tres categorías de riesgo de muerte.…”