Clinical Analysis Of Community-Acquired Pneumonia (CAP) In The Elderly

OBJECTIVE Community-acquired pneumonia (CAP) in the elderly has a high morbidity and mortality. Knowledge of the risk factors in the elderly with CAP may help in the diagnosis, treatment and prognosis of these patients.METHODS A retrospective, 2-year study was carried out to assess the clinical characteristics, aetiology, evolution and prognostic factors of elderly patients (. 65 yrs) admitted to the Second Affiliated Hospital, Medical School of Zhejiang University for CAP. We used Acute Physiology and Chronic Health Evaluation II (APACHE II) and the Pneumonia Severity Index(PSI) for assessing the severity of CAP. The Chi-squared test and logistic regression model were used for analyzing the risk factors.RESULTS A total of 111 patients were included. 91 patients(82.0%) had received some antibiotic treatment prior to hospital admission; 42 patients(37.8%) were confined to bed; 83 patients(74.8%) had one or more underlying disease. The most frequent symptoms were cough, expectoration, fever and altered mental status. The microbial agents found most frequently were gram-negative bacilli (69.6%) and staphylococci(18.8%). The mean hospital stay was 14.6±11.3 days, and a total of 28 (25.2%) patients died. We found the following factors associated with mortality in the univariate analysis: bed confinement, the state of underlying diseases, the existence of neurological disease, alteration in mental status, albumin values <3.0g/dl, high level of D-dimer, ICU admission, shock, renal falure, mechanical ventilation, high APACHE II score, high PSI score. There were three independent risk factors: previous bed confinement [OR(odds ratio) 5.134, 95%CI(confidence interval): 1.021-25.832], shock (OR 5.809, 95%CI: 1.342-25.147) and APACHE II score (OR 6.778, 95%CI: 1.946-23.607).CONCLUSIONS We conclude that clinical characteristics of CAP in the elderly are cough, expectoration, fever. But sometimes it is represented as mental alteration. Most common pathogens are gram-negative bacilli and staphylococci. Previous bed confinement, shock and high APACHE II score are independent risk factors associated with greater mortality.