Turkish Journal of Geriatrics 2020 , Vol 23, Issue 3
INDEPENDENT PROGNOSTIC INDICATORS IN THE ELDERLY WITH PNEUMONIA: A SINGLECENTRE PROSPECTIVE OBSERVATIONAL STUDY
Serkan SÜRME1, İlker İnanç BALKAN1, Osman Faruk BAYRAMLAR2, Ritvan KARA ALİ1, Bilgül METE1, Günay CAN3, Fehmi TABAK1, Neşe SALTOĞLU1
1Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
2Istanbul University, Istanbul Medical Faculty, Public Health, İstanbul, Turkey
3Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Public Health, İstanbul, Turkey
DOI : 10.31086/tjgeri.2020.170 Background: The goal of this study was to identify and investigate the indicators of a poor prognosis in the elderly with pneumonia.

Material-Method: In this prospective observational study, the patients with pneumonia were stratified into younger (18 to 64 years) and older (more than 65 years) groups. The poor prognostic indicators were determined and compared.

Results: A total of 184 pneumonia episodes in 151 patients were recorded. The median age was 72 (18-104) of whom 127 (69%) were more than 65 years old and 110 (59.8%) were male. A multivariate regression analysis identified three variables that could be potential independent risk factors for a poor prognosis in the elderly: 1) dyspnea at the onset (OR:5.85, CI:5.18-6.52, p=0.01), 2) use of antibiotics within the last three months (OR:2.97, CI:2.51-3.43, p=0.02) and 3) acute renal failure (OR:2.51, CI:2.06-2.96, p=0.04). A receiver operating characteristic analysis showed that the areas under the curves of procalcitonin and C-reactive protein as indicators of a poor prognosis in the elderly were 0.846 (p<0.001) and 0.650 (p=0.008). In addition, changes in mental status (p<0.001), confusion, blood urea nitrogen, respiratory rate, blood pressure, and age ?65 years score (p<0.001) and pneumonia severity index (p<0.001) were associated with a poor prognosis.

Conclusion: Dyspnea at the onset, use of antibiotics within the last three months, acute renal failure, serum C-reactive protein and procalcitonin levels should be carefully evaluated to determine the need for hospitalization, intensive care, and initial antimicrobial therapy. Keywords : Aging; Pneumonia; Prognosis