Neumonía adquirida en la comunidad en ancianos que requieren internación. Cuadro clínico y pronostico. / [Community-acquired pneumonia in the elderly requiring hospitalization. Clinical features and prognosis]
Díaz Fuenzalida, A; Vera, C; Santamarina, J; Izarduy, L; Bagnasco, R; Grinspon, S; Khoury, M; Rodríguez, C H; Luna, C M.
Medicina [B Aires]
; 59(6): 731-8, 1999.
Artículo
en Español
| BINACIS | ID: bin-40159
We evaluated retrospectively 96 patients older than 64 years admitted with the diagnosis of Community Acquired Pneumonia (CAP) in order to describe the clinical features, evaluate severity and assess prognostic factors. During an 18-month period 100 cases of CAP were included. Average age was 82.3 years +/- 8.3 (+/- SD). By the time of admission, cough and fever were found in 35
of cases and 48
had altered mental status. Fourteen per cent needed mechanical ventilation. Etiology was determined in 21
of cases. Most common pathogens were S. pneumoniae (38.1
), S. aureus (19
) and H. infuenzae (14.3
). Overall mortality was 29
. The most commonly present criteria of severity were tachypnea (respiratory rate > 30) and a PaO2/FIO2 ratio < 250. Severe pneumonia was found in 60
of patients and mortality in that group was 40
. Multivariate analysis demonstrated that some independent prognostic factors were associated with higher mortality: requirement of vasopressors (Odds Ratio [OR] = 22.0; 95
confidence interval [CI] = 1.9-249.5), oliguria (OR = 9.9; CI = 1.5-66.2), previous neurologic disease (OR = 8.2; CI = 1.8-36.6), PaCO2 > 44 mm/Hg (OR = 6.9; CI = 1.1-43.2), and creatinine > 1.4 mg/dl (OR = 4.7; CI = 1.2-19.1). We conclude that CAP features in elderly patients requiring hospitalization are atypical, severe presentations are frequent and mortality is high. Prognostic factors as found in this study can help the evaluating physician to identify those who require special care.
of cases and 48
had altered mental status. Fourteen per cent needed mechanical ventilation. Etiology was determined in 21
of cases. Most common pathogens were S. pneumoniae (38.1
), S. aureus (19
) and H. infuenzae (14.3
). Overall mortality was 29
. The most commonly present criteria of severity were tachypnea (respiratory rate > 30) and a PaO2/FIO2 ratio < 250. Severe pneumonia was found in 60
of patients and mortality in that group was 40
. Multivariate analysis demonstrated that some independent prognostic factors were associated with higher mortality: requirement of vasopressors (Odds Ratio [OR] = 22.0; 95
confidence interval [CI] = 1.9-249.5), oliguria (OR = 9.9; CI = 1.5-66.2), previous neurologic disease (OR = 8.2; CI = 1.8-36.6), PaCO2 > 44 mm/Hg (OR = 6.9; CI = 1.1-43.2), and creatinine > 1.4 mg/dl (OR = 4.7; CI = 1.2-19.1). We conclude that CAP features in elderly patients requiring hospitalization are atypical, severe presentations are frequent and mortality is high. Prognostic factors as found in this study can help the evaluating physician to identify those who require special care.
Biblioteca responsable:
AR2.1
Documentos relacionados