Geriatric Assessment and Prognostic Factors of Mortality in Very Elderly Patients With Community-Acquired Pneumonia

Introduction: To assess the relationship between the parameters obtained in the geriatric assessment and mortality in elderly people with community-acquired pneumonia in an acute care geriatric unit. Methods: Four hundred fifty-six patients (>= 75 years). Variables: age, sex, referral source, background, consciousness level, heart rate, breathing rate, blood pressure, laboratory data, pleural effusion, multilobar infiltrates, functional status (activities of daily living) prior to admission [Lawton index (LI), Barthel index (BIp)] prior to and at admission (BIa), cognitive status [Pfeiffer test (PT)], comorbidity [Charlson index (ChI)] and nutrition (total protein, albumin). Results: A hundred ten patients died (24.2%) during hospitalization. These patients were older (86.6 +/- 6.4 vs 85.1 +/- 6.4, P<.04), had more comorbidity (ChI 2.35 +/- 1.61 vs 2.08 +/- 1.38; P<.083), worse functional impairment [(LI: 0.49 +/- 1.15 vs 1.45 +/- 2.32, P<.001) (BIp: 34.6 +/- 32.9 vs 54.0 +/- 34.1, P<.001) (BIa: 5.79 +/- 12.5 vs 20.5 +/- 22.9, P<.001)], a higher percentage of functional loss at admission (85.9 +/- 23.2 vs 66.4 +/- 28.6; P<.0001), worse cognitive impairment (PT: 7.20 +/- 3.73 vs 5.10 +/- 3.69, P<.001) and malnutrition (albumin 2.67 +/- 0.54 vs 2.99 +/- 0.49, P<.001). Mortality was higher with impaired consciousness [49.2% (P<.01)], tachypnea [33.3% (P<.01)], tachycardia [44.4% (P<.002), high urea levels [31.8 (P<.001)], anemia [44.7% (P<.02)], pleural effusion [42.9% (P<.002)], and multilobar infiltrates [43.2% (P<.001)]. In the multivariate analysis, variables associated with mortality were: age >= 90 years [OR: 3.11(95% CI: 1.31 to 7.36)], impaired consciousness [3.19 (1.66 to 6.15)], hematocrit <30% [2.87 (1.19 to 6.94)], pleural effusion [3.77 (1.69 to 8.39)] and multilobar infiltrates [2.76 (1.48 to 5.16)]. Female sex and a preserved functional status prior (LI >= 5) and during admission (BIa >= 40) were protective of mortality [0.40 (0.22 to 0.70), 0.09 (0.01 to 0.81) and 0.11 (0.02 to 0.51)]. Conclusions: Geriatric assessment parameters and routine clinical variables were associated with mortality. (C) 2013 SEPAR. Published by Elsevier Espana, S.L.U. All rights reserved.