Early procalcitonin determination in the emergency department and clinical outcome of community-acquired pneumonia in old and oldest old patients

Background: Aspiration pneumonia (AsP), a phenotype of community-acquired pneumonia (CAP), is a common and problematic disease with symptomless recurrence and fatality in old adults. Characteristic factors for distinguishing AsP from CAP need to be determined to manage AsP. No such factorial markers in oldest-old adults, who are often seen in the primary-care settings, have yet been established. Methods: From the database of our Primary Care and General Practice Study, including the general backgrounds, clinical conditions and laboratory findings collected by primary care physicians and general practitioners, the records of 130 patients diagnosed with either AsP (n = 72) or CAP (n = 58) were extracted. Characteristic factors associated with the diagnosis of AsP were statistically compared between AsP and CAP. Results: The patients were older in the AsP group (median 90 years old) than in the CAP group (86 years old). The body temperature, heart rate, and diastolic blood pressure were lower in the patients with AsP than in those with CAP. Witnessed meal dysphagia by families and caregivers was reported only in AsP. Living in a nursing home, comorbidities of cerebral infarction and dementia (as positive factors) and hypertension (as a negative factor) were considered predictive to diagnose AsP in a stepwise logistic regression analysis. Conclusions: Among oldest-old adults in primary-care settings, living in a nursing home and the dysphagia risks are suggested to be characteristic factors for diagnosing AsP. Age and some relevant clinical information may help manage AsP and also be useful for families and caregivers.

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P-328: Predictors of long-term mortality in oldest old patients (90+) hospitalized in medical wards via the emergency department

European Geriatric Medicine ◽

10.1016/s1878-7649(15)30425-3 ◽

2015 ◽

Vol 6 ◽

pp. S119

Author(s):

P. de Boissieu ◽

R. Mahmoudi ◽

J.-L. Novella ◽

F. Blanchard ◽

D. Jolly ◽

...

Keyword(s):

Emergency Department ◽

Oldest Old ◽

Old Patients ◽

Medical Wards ◽

Long Term Mortality

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Predictors of long-term mortality in oldest old patients (90+) hospitalized to medical wards via the emergency department: The safes cohort

The journal of nutrition health & aging ◽

10.1007/s12603-015-0515-y ◽

2015 ◽

Vol 19 (6) ◽

pp. 702-707 ◽

Cited By ~ 6

Author(s):

P. De Boissieu ◽

R. Mahmoudi ◽

M. Hentzien ◽

S. Toquet ◽

J. -L. Novella ◽

...

Keyword(s):

Emergency Department ◽

Oldest Old ◽

Old Patients ◽

Medical Wards ◽

Safes Cohort ◽

Long Term Mortality

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qSOFA as a new community-acquired pneumonia severity score in the emergency setting

Emergency Medicine Journal ◽

10.1136/emermed-2019-208789 ◽

2020 ◽

pp. emermed-2019-208789

Author(s):

Ornella Spagnolello ◽

Giancarlo Ceccarelli ◽

Cristian Borrazzo ◽

Angela Macrì ◽

Marianna Suppa ◽

...

Keyword(s):

Emergency Department ◽

Mortality Rate ◽

Community Acquired Pneumonia ◽

Mortality Prediction ◽

Emergency Setting ◽

Old Patients ◽

Suspected Infection ◽

Icu Admission ◽

Prediction Of Mortality ◽

Qsofa Score

BackgroundQuick Sequential Organ Failure Assessment (qSOFA) score is a bedside prognostic tool for patients with suspected infection outside the intensive care unit (ICU), which is particularly useful when laboratory analyses are not readily available. However, its performance in potentially septic patients with community-acquired pneumonia (CAP) needs to be examined further, especially in relation to early outcomes affecting acute management.ObjectiveFirst, to compare the performance of qSOFA and CURB-65 in the prediction of mortality in the emergency department in patients presenting with CAP. Second, to study patients who required critical care support (CCS) and ICU admission.MethodsBetween January and December 2017, a 1-year retrospective observational study was carried out of adult (≥18 years old) patients presenting to the emergency department (ED) of our hospital (Rome, Italy) with CAP. The accuracy of qSOFA, qSOFA-65 and CURB-65 was compared in predicting mortality in the ED, CCS requirement and ICU admission. The concordance among scores ≥2 was then assessed for 30-day estimated mortality prediction.Results505 patients with CAP were enrolled. Median age was 71.0 years and mortality rate in the ED was 4.7%. The areas under the curve (AUCs) of qSOFA-65, CURB-65 and qSOFA in predicting mortality rate in the ED were 0.949 (95% CI 0.873 to 0.976), 0.923 (0.867 to 0.980) and 0.909 (0.847 to 0.971), respectively. The likelihood ratio of a patient having a qSOFA score ≥2 points was higher than for qSOFA-65 or CURB-65 (11 vs 7 vs 6.7). The AUCs of qSOFA, qSOFA-65 and CURB-65 in predicting CCS requirement were 0.862 (95% CI 0.802 to 0.923), 0.824 (0.758 to 0.890) and 0.821 (0.754 to 0.888), respectively. The AUCs of qSOFA-65, qSOFA and CURB-65 in predicting ICU admission were 0.593 (95% CI 0.511 to 0.676), 0.585 (0.503 to 0.667) and 0.570 (0.488 to 0.653), respectively. The concordance between qSOFA-65 and CURB-65 in 30-day estimated mortality prediction was 93%.ConclusionqSOFA is a valuable score for predicting mortality in the ED and for the prompt identification of patients with CAP requiring CCS. qSOFA-65 may further improve the performance of this useful score, showing also good concordance with CURB-65 in 30-day estimated mortality prediction.

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