Mortalidad en pacientes con neumonía provenientes de geriátrico: estudio caso-control / Mortality in Patients with Pneumonia from Nursing Homes: Case-control Study
Rev. am. med. respir
; 13(3): 133-139, set. 2013. tab
Article
in Es
| LILACS
| ID: lil-694826
Responsible library:
AR423.1
RESUMEN
Introducción:
La neumonía en adultos mayores institucionalizados en geriátricos presenta elevada incidencia y mortalidad. Conocer sus características permite optimizar conductas terapéuticas.Objetivo:
Comparar severidad, etiología, regímenes antibióticos utilizados y evolución de una cohorte de pacientes hospitalizados por neumonía provenientes de geriátrico, con un grupo de pacientes de igual edad no residentes en geriátricos. Material ymétodos:
Estudio multicéntrico, retrospectivo, caso-control, sobre la base de datos internacional CAPO. Se incluyeron 534 pacientes internados en hospitales de Argentina por neumonía, periodo 6/2001-12/2007; 30 pacientes provinieron de geriátrico (casos); por cada caso se seleccionaron 3 controles de edad similar. Análisis estadístico ?2 y F-ANOVA. Se aplicó análisis univariado y multivariado.Resultados:
Edad media 85,7 (DS 6.46) y 84.8 (DS 5.8) años para casos y controles respectivamente, pNS. Los casos presentaron categorías de PSI significativamente mayores (p < 0.0001). La etiología se determinó en 17% de casos y 27% de controles. Los antibióticos utilizados fueron similares en ambos grupos (p = 0.7). No hubo diferencias significativas en tiempo a la estabilidad clínica ni duración de estadía hospitalaria. La mortalidad global en los casos fue 50% vs 26% en controles; (p = 0.02) y la atribuible 43.3% vs 15.5%; (p = 0.002). Análisis multivariado Accidente cerebro vascular (ACV) (p = 0.05), estado mental alterado (EMA) (p = 0.01) e hipotensión arterial (p = 0.04) fueron las variables significativamente asociadas a mortalidad.Conclusiones:
los pacientes provenientes de geriátrico presentaron neumonías más severas y mayor mortalidad. Esta se asoció con la presencia de ACV previo, EMA e hipotensión arterial al ingreso, y no con la condición de provenir de geriátrico.ABSTRACT
Introduction:
Community-acquired pneumonia (CAP) in institutions for elderly patients presents high incidence and mortality. Defining its characteristics will contribute to optimize therapeutic measures.Objective:
To compare severity, etiology, antibiotic regimens used and outcome of a cohort of nursing home residents with CAP with a group of age-matched patients who are not resident at a nursing home.Methods:
Multicenter, retrospective, case-control study. Information was taken from the international database CAPO. We included 534 patients hospitalized for CAP in Argentina, from June 2001 to December 2007. Among them, 30 cases were residents in nursing homes (cases). For each case, three controls of similar age were selected. Statisticalanalysis:
?2 and F-ANOVA. Univariate and multivariate analyses were performed.Results:
Mean age was 85.7 (SD 6.46) and 84.8 (SD 5.8) years for cases and controls respectively, p NS. Cases had significantly higher PSI scores (p < 0.0001). The etiology was determined in 17% of cases and 27% of controls. The antibiotics used were similar in both groups (p = 0.7). There was no significant difference in time to reach clinical stability or in length of hospital stay. Overall mortality was 50% in cases vs 26% in controls, (p = 0.02) and attributable mortality was 43.3% and 15.5% respectively (p = 0.002). In the multivariate analysis, stroke (p = 0.05), confusion (p = 0.01) and hypotension (p = 0.04) were associated significantly with mortality.Conclusions:
nursing home residents presented more frequently severe pneumonia with increased mortality. This incidence was associated with the presence of previous stroke, confusion and hypotension on admission; it was not associated with residence in a nursing home.Key words
Full text:
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Index:
LILACS
Main subject:
Pneumonia
/
Aged
/
Mortality
/
Geriatric Hospitals
Type of study:
Clinical_trials
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Language:
Es
Journal:
Rev. am. med. respir
Journal subject:
MEDICINA
/
PNEUMOLOGIA
Year:
2013
Type:
Article