Outcome Predictors of Pneumonia in Elderly Patients: Importance of Functional Assessment

Torres, Olga; Muñoz, José Bernal; Ruiz, Domingo; Ris, Josep; Gich, Ignasi; Coma, Eva; Gurguí, Mercé; Vázquez, Guillermo

doi:10.1111/j.1532-5415.2004.52492.x

Cited by 193 publications

(156 citation statements)

References 24 publications

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“…21 Viral infection in nursing homes is seasonal. 22,23 In the present study, we also found seasonality of the H1N1 epidemic in NHAP cases, particularly in region II (39% vs 13%, P ϭ .16).…”

Section: Etiologysupporting

confidence: 59%

A Worldwide Perspective of Nursing Home-Acquired Pneumonia Compared With Community-Acquired Pneumonia

et al. 2013

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the Community-Acquired Pneumonia Organization (CAPO) Investigators BACKGROUND: Nursing home-acquired pneumonia (NHAP) is the leading cause of death among long-term care patients and the second most common cause of transfers to acute care facilities. The aim of this study was to characterize the incidence, microbiology, and outcomes for hospitalized patients with community-acquired pneumonia (CAP) and NHAP. METHODS: A secondary analysis of 5,160 patients from the Community-Acquired Pneumonia Organization database was performed. World regions were defined as the United States and Canada (I), Latin America (II), and Europe (III). RESULTS: From a total of 5,160 hospitalized patients with CAP, NHAP was identified in 287 (5.6%) patients. Mean age was 80 y. NHAP distribution by region was 6% in region I, 3% in region II, and 7% in region III. Subjects with NHAP had higher frequencies of neurological disease, diabetes mellitus, congestive heart failure, and renal failure than did subjects with CAP (P < .001). ICU admission was required in 32 (12%) subjects. Etiology was defined in 68 (23%) subjects with NHAP and 1,300 (27%) with CAP. The most common pathogens identified in NHAP included Streptococcus pneumoniae (31%), Staphylococcus species (31%), and Pseudomonas aeruginosa (7%). Presentation of NHAP more frequently included pleural effusions (34% vs 21%, P < .001) and multilobar involvement (31% vs 24%, P < .001). Thirty-day hospital mortality was statistically greater among subjects with NHAP than among those with CAP (42% vs 18%, P < .001). CONCLUSIONS: Worldwide, only a very small proportion of hospitalized patients with CAP present with NHAP; the poor outcomes for these patients may be due primarily to a higher number of comorbidities compared with patients without NHAP.

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Section: Etiologysupporting

confidence: 59%

A Worldwide Perspective of Nursing Home-Acquired Pneumonia Compared With Community-Acquired Pneumonia

et al. 2013

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“…Such flexibility is widely validated in similar settings. [33][34][35][36] It also appears to us to be analogous to the advanced computing techniques that we have used in recent inquiries to enhance the performance of the high-dimension Frailty Index. 15,37 For instance, an artificial neural network can be used to calculate weighted scores, and can significantly improve the Frailty Index's predictive performance over an unweighted version.…”

Section: Discussionmentioning

confidence: 99%

A global clinical measure of fitness and frailty in elderly people

Rockwood¹

2005

Canadian Medical Association Journal

6,613

5,413

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“…Nosocomial pneumonia remains one of the major causes of morbidity and mortality. 1,2 Re-evaluation at 72 h after treatment is crucial to detect treatment failure as well as to prevent other complications. 3,4 Unfortunately, traditional parameters fail to assess the clinical efficacy at an earlier stage.…”

Section: Introductionmentioning

confidence: 99%

Procalcitonin Kinetics and Nosocomial Pneumonia in Older Patients

Shi

Xu²,

Rui

et al. 2013

Respir Care

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BACKGROUND: Early identification of treatment failure for nosocomial pneumonia remains a major challenge. The goal of this study was to test whether procalcitonin kinetics can be used to assess the clinical efficacy in older critically ill patients with nosocomial pneumonia. METHODS: A prospective observational study was conducted with 60 subjects (> 65 y old) admitted to the ICU with severe nosocomial pneumonia. Serum procalcitonin was measured on days 0, 3, and 7 and at the end of treatment. The procalcitonin time course was analyzed according to the therapeutic efficacy. RESULTS: Procalcitonin levels were elevated in all subjects (n ‫؍‬ 60) on day 0, and the median level (range) was 2.5 (0.85-42.7) g/L. There were no differences in procalcitonin between the improved subjects (n ‫؍‬ 41) and those without improvement (n ‫؍‬ 19) on day 0 (P > .05). However, lower procalcitonin levels on days 3 and 7 and at the end of treatment (all P < .05) and greater rates of procalcitonin decline between days 0 and 3 (⌬PCT d3 %; 29.5 ؎ 10.8% vs 15.1 ؎ 5.9%, P ‫؍‬ .009) were observed in the improved subjects compared with those with no improvement. ⌬PCT d3 % was the best single predictor of efficacy (area under the curve of 0.79, P < .001) and had a sensitivity of 75.7% and a specificity of 72.0% with a threshold of 26.2%. By comparison, traditional parameters and absolute procalcitonin failed to predict treatment response (P > .05). Indeed, the combination of ⌬PCT d3 % > 26.2% and a modified Clinical Pulmonary Infection Score of < 6 points improved the predictive value (area under the curve of 0.89, sensitivity of 81.3%, specificity of 86.5%). CONCLUSIONS: Procalcitonin levels were not influenced by aging, and procalcitonin kinetics might help to identify treatment failure. ⌬PCT d3 % in combination with the Clinical Pulmonary Infection Score has been shown to be a marker of clinical efficacy at an earlier stage.

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Outcome Predictors of Pneumonia in Elderly Patients: Importance of Functional Assessment

Cited by 193 publications

References 24 publications

A Worldwide Perspective of Nursing Home-Acquired Pneumonia Compared With Community-Acquired Pneumonia

A Worldwide Perspective of Nursing Home-Acquired Pneumonia Compared With Community-Acquired Pneumonia

A global clinical measure of fitness and frailty in elderly people

Procalcitonin Kinetics and Nosocomial Pneumonia in Older Patients

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