Clinical presentation and predictors of outcome in adult patients with community-acquired pneumonia

Background. Community-acquired pneumonia in adults has a morbidity and mortality ranging between 10% and 25%. Increasing age is associated with a higher mortality. The factors influencing the outcome in elderly patients are thought to be different from those in young adults. We, therefore, studied the clinical profile and predictors of outcome in adults with community-acquired pneumonias. Methods. Seventy-two consecutive patients with community-acquired pneumonia were included in the study over a period of 18 months. A detailed history was obtained and physical examination done. A chest X-ray was done to establish the diagnosis and haematological, biochemical and arterial blood gas estimations were carried out. The data of survivors and non-survivors as well as those greater than or equal to 50 years of age and <50 years were analysed to determine the clinical profile and outcome in these groups. Results. The clinical features, laboratory parameters and complications from pneumonia were similar in 43 elderly (group I, age greater than or equal to 50 years) and 29 young (group II, age <50 years) subjects. Thirty-five per cent of elderly patients and 14% of young patients succumbed to fulminant sepsis or respiratory failure (p<0.05). Old age, history of smoking, presence of chronic obstructive airways disease, late presentation to hospital, systolic and diastolic hypotension, high blood urea, low serum albumin and development of septic shock were associated with a higher incidence of complications and a poorer prognosis. In addition, older patients with a poor outcome also had symptoms for a longer duration and a poor neutrophilic response to infection. Conclusions. The presence of certain factors leads to a higher incidence of complications and a poorer prognosis. These factors are good predictors of outcome in adults of all age groups.