Abstract
Background: The aim of this study was to investigate poor prognostic indicators in the elderly with pneumonia. Methods: In this prospective observational study, the patients with pneumonia were stratified into younger (18-64 years) and older (≥65 years) groups. The poor prognostic indicators were determined and compared. Results: There were 184 pneumonia episodes in 155 patients. The median age of the cases was 72 (range, 18-104) of whom 127 (69%) were ≥65 years old and 110 (59.8%) were male. Mental status changes were more common in the elderly group (p=0.04). Multivariate regression analysis determined three variables that could be potential independent risk factors for poor prognosis in the elderly: dyspnea at the onset (OR:5.85, CI:5.18-6.52, p=0.01), previous antibiotic use within the last 3 months (OR:2.97, CI:2.51-3.43, p=0.02), acute renal failure (OR:2.51, CI:2.06-2.96, p=0.04). A receiver operating characteristic (ROC) analysis showed that the area under the curves (AUC) of procalcitonin and C-reactive protein (CRP) as indicators of poor prognosis in the elderly were 0.846 (p<0.001) and 0.650 (p=0.008) respectively. In addition, mental status changes (p<0.001), the confusion, blood urea nitrogen, respiratory rate, blood pressure, and age ≥65 years (CURB-65) score (p<0.001), and the pneumonia severity index (PSI) (p<0.001) were associated with poor prognosis. Conclusion: Dyspnea at the onset, previous antibiotic use within the last 3 months, acute renal failure, serum CRP and procalcitonin levels along with the PSI and the CURB-65 scores should be carefully evaluated in terms of hospitalization, the need for intensive care unit admission and the initial antimicrobial therapy.
Intravenous antibiotic use and exacerbation events in an adult cystic fibrosis centre: A prospective observational study