Prognostic Factors For Severe Community-acquired Pneumonia In Elderly Patients

Objective:To investigate prognostic factors in elderly patients with severe co mmunity-acquired pneumonia (CAP). Methods:Elderly patients (>75 years old) wit h severe CAP admitted to the Respiratory Intensive Care Unit (RICU) of the First Affiliated Hospital of Xinjiang Medical University were enrolled. All patients met t he diagnostic criteria for severe CAP, and were mechanically ventilated via endotra cheal intubation using synchronized intermittent mandatory ventilation (SIMV) or as sistant/control ventilation (A/C). Sequential noninvasive ventilation (NIV) following early extubation or continuing mechanical ventilation via endotracheal intubation wa s administered in all subjects. Whenever necessary, fiberoptic bronchoscopy was use d to remove endotracheal secretions. Data regarding sex, age and concurrent diseas es was recorded, as well as the Acute Physiology and Chronic Health Evaluation (APACHE) II and severe pneumonia scores. In addition, the duration of invasive m echanical ventilation, total duration of any mechanical ventilation, number of episod es of ventilator-associated pneumonia, numbers of aspiration and endotracheal intub ation events and other ventilation-related parameters were recorded. The data were analyzed using a logistic regression model. Results:Ninety-one cases were eligible. In the univariate analysis, concurrent cerebrovascular infarction, duration of invasiv e mechanical ventilation, total duration of mechanical ventilation, APACHE Ⅱ score, CURB-75 score (Confusion, blood Urea nitrogen, Respiratory rate, systolic or dias tolic Blood pressure, and age>75 yr), pneumonia severity index (PSI), PaO2/FiO2 r atio on admission, and intubation events (>2 times) were related to patient outcome (survival or death) (PO.05 for all). Multivariate logistic regression analysis reveal ed that concurrent cerebrovascular infarction (OR=0.18, P=0.007), PaO2/FiO2 ratio (OR=9.86, P=0.000), and intubations (>2 episodes; OR=8.43,P=0.001) were indepe ndently associated with poor patient outcomes. Conclusion:For elderly patients wit h severe CAP, concurrent cerebrovascular infarction, poor PaO2/FiO2 ratios, and two or more intubation events were independently predictive of a poor patient outcome.