The Impact of Age and Comorbidities on the Mortality of Patients of Different Age Groups Admitted with Community-Acquired Pneumonia.
Ann Am Thorac Soc. 2016 Jul 11;
Authors: Luna CM, Palma I, Niederman MS, Membriani E, Giovini V, Wiemken TL, Peyrani P, Ramirez J
RATIONALE: Comorbidities, age, severity of illness and high risk pathogens are well known outcome determinants in community-acquired pneumonia (CAP); how these factors interact has not yet been clarified.
OBJECTIVES: We conducted this study to analyze the complex interaction of comorbidities, age, illness severity and pathogens in relation to community-acquired pneumonia.
METHODS: We performed a secondary analysis of the CAPO database, to evaluate the impact of age (in age groups <65, 65-79 and ≥80 years-old), comorbidities (malignant disease, COPD, renal and liver disease, cerebrovascular accident, congestive heart failure, and diabetes mellitus), severity of illness at admission, and etiology, on the mortality of patients admitted with CAP.
MEASUREMENTS AND MAIN RESULTS: 6205 patients met the inclusion criteria, and 508 (8.2%) died within 30 days. Factors independently associated with mortality were malignant disease, congestive heart failure, cerebrovascular accident, renal disease, diabetes mellitus, altered mental status, hypoxemia, pleural effusion, hematocrit <30%, requirement for mechanical ventilation and age ≥80 years-old. A total of 1699 pathogens were defined in 1545 cases; etiology was the same for all age groups. In the overall population, mortality increased with the age; but etiology was not associated with mortality. Considering the patients with ≤1 comorbidity, mortality was not different comparing age groups <65 with 65-79 years-old, but was higher for those aged ≥80 years-old.
CONCLUSIONS: The presence of comorbidities is associated with poorer outcomes in CAP. However, when <1 comorbidity was present; age≥80 years became a factor increasing mortality. From a clinical standpoint this study suggests that age ≥80 years, instead of ≥65 years, should be considered a risk factor for poor outcome in CAP.
PMID: 27398827 [PubMed - as supplied by publisher]