Sobrevida a largo plazo en adultos inmunocompetentes mayores de 60 años hospitalizados por neumonía adquirida en la comunidad / Long-term survival of immunocompetent patients older than 60 years hospitalized for community-acquired pneumonia

Background: A reduction in long-term survival of adult patients hospitalized with community-acquired pneumonia (CAP), especially older people with múltiple comorbidities, has been reported. Aim: To examine the clinical variables associated to mortality at 72 months of adult patients older than 60 years hospitalized with CAP and compare their mortality with a control group matched for age, gender and place of admission. Material and Methods: Prospective assessment of 465 immunocompetent patients aged 61 to 101 years, hospitalized for CAP in a teaching hospital. Hospital and 30 day mortality was obtained from medical records. Seventy two months survival ofthe 424 patients who were discharged olive, was compared with a group of 851 patients without pneumonia paired for gender and age. Mortality at 72 months was obtained from death certificates. Results: Eighty seven percent of patients had comorbidity. The median hospital length ofstay was 10 days, 8.8% died in the hospital, 29.7% at one year follow-up and 61.9%o at 6 years. The actuarial survival at six years was similar in the cohort of adults hospitalized with CAP and the control group matched for age, gender and site of care. In a multivariate analysis, the clinical variables associated with increased risk of dying during long-term follow-up were older age, chronic cardiovascular and neurological diseases, malignancy, absence of fever, low C-reactive protein at hospital admission and high-risk parameters of the Fine índex. Conclusions: Advanced age, some specific comorbidities, poor systemic inflammatory response at admission and high risk parameters of the Fine Index were associated to increased risk of dying on long-term follow-up among older adults hospitalized for CAP.

Predictores clínicos de mortalidad en el seguimiento a mediano plazo en pacientes adultos inmunocompetentes hospitalizados por neumonía adquirida en la comunidad / Predictors of one year mortality among immunocompetent adults hospitalized for community-acquired pneumonia

Background: Mortality increases in adults, especially in older adults, after recovery from an episode of community-acquired pneumonia (CAP). Aim: To analyze survival and predictors of death at one year follow up of a cohort of adult patients hospitalized with CAP. Material and Methods: Immunocompetent patients admitted to a clinical hospital for an episode of CAP were included in the study and were assessed according to a standardized protocol. One year mortality after admission was assessed using death records of the National Identification Service. Clinical and laboratory variables measured at hospital admission associated with risk of death at one year follow up were subjected to univariate and multivariate analysis by a logistic regression model. Results: We evaluated 659 patients aged 68 ± 19 years, 52% were male, 77% had underlying conditions (especially cardiovascular, neurological and respiratory diseases). Mean hospital length of stay was 9 days, 7.1% died during hospital stay and 15.8% did so during the year of follow-up. A causal agent was identified in one third of cases. The main pathogens isolated were Streptococcus pneumoniae (12.9%), Haemophilus influenzae (4.1%), respiratory viruses (6.5%) and Gram-negative bacilli (6.5%). In multivariate analysis, the clinical variables associated with increased risk of dying during the year of follow-up were older age, chronic neurological disease, malignancies, lack of fever at admission and prolonged hospital length of stay. Conclusions: Age, specific co-morbidities such as chronic neurological disease and cancer, absence of fever at hospital admission and prolonged hospital length of stay were associated with increased risk of dying during the year after admission among adult patients hospitalized with community-acquired pneumonia.