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Which Elderly CAP Outpatients Have the Highest Risk for Death?

Among patients 65 to 74 years old, community-acquired pneumonia (CAP) is a common reason for hospitalization; among those 85 years or older, CAP is a leading reason for hospitalization. Models developed to determine the severity of inpatient CAP may not apply to outpatients in primary care who have lower-respiratory-tract infections (LRTI). This 2-year study in northern Finland included 950 community-dwelling patients, 65 years or older, with LRTI and signs suggesting CAP.

Thirty-eight patients (4.1%) died within 30 days after the initial visit (the study's primary endpoint); 14 (37%) of these deaths occurred within the first week. Deaths were unrelated to initial place of treatment. Variables significantly associated with mortality were acute aggravation of a coexisting illness, older age (median, 80 years for those who died, vs. 75 years among survivors), higher respiratory rate (median, 26 vs. 22 respirations/minute) higher WBC count (median, 12.2 vs. 9.3 cells x 10³ ug/L), and higher C-reactive protein (CRP) levels (median, 136 vs. 76 mg/L). In a stepwise regression model based on 719 cases, independent relative risk factors for death within 30 days were acute aggravation of coexisting illness, respiratory rate 25 respirations/minute, and CRP level 100 mg/L. The 30-day mortality rate for patients with 1 independent risk factor was 2.2%; with all 3 risk factors, it was 20%.

Comment: The information generally available for elderly primary care patients with LRTI, although limited, may prove useful in identifying patients at high risk for death from CAP. This study demonstrated that at least 3 easily measured parameters were independently associated with mortality within 30 days. These findings, however, require validation in additional prospective studies.

— Hartmut M. Lode, MD

Published in Journal Watch Infectious Diseases January 24, 2002

Citation(s):

Seppa Y et al. Severity assessment of lower respiratory tract infection in elderly patients in primary care. Arch Intern Med 2001 Dec 10/24; 161:2709-13.

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