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.
Acute renal failure in the ICU setting: A prospective observational study
