Age, comorbidities or other antecedents and data from clinical, radiographic and laboratory evaluation are usually considered risk factors (RF) and are commonly used to decide about the site of care of patients with CAP. Our purpose was to evaluate the relationship between the presence of RF and outcome of patients with CAP.
Prospective evaluation of outcome in 802 patients surveyed during the ENNAC (Argentinean nationwide CAP epidemiology study). RF considered included antecedents: age > 65; comorbidities (chronical pulmonary, cerebrovascular, neuromuscular, cardiac, hepatic or renal disease, diabetes, congestive heart failure, malignancy or immunocompromise); alcohol abuse or prior admission for CAP; physical exam abnormalities: altered consciousness, tachycardia, tachypnea, hypotension; and severe laboratorial (leukocytosis or leukopenia, anemia, uremia, hypoxemia, acidosis) or radiographic (multilobar or bilateral) abnormalities. Pneumonia severity index (PSI) was calculated.
467 patients were admitted (117 in the ICU) while 335 were outpatients; 56 patients died during the 30 days following the diagnosis. At least one RF was present in 640 patients, including 345 older than 65 years, and 295 younger, with some other risk factor. All 412 patients having < 3 RFs survived; 313 patients had ≥ 4 RFs, including 55 non-survivors. 83 patients older than 65 years (73.7 ± 5.8) were cared as outpatients, all of them recovered from CAP without complications, including 34 with ≥ 2 RFs and 18 with ≥ 3 RFs.
Independently to the presence of RFs or the PSI score, clinical evaluation was effective to choose the site of care. CAP patients having < 4 RFs should be considered candidates for management as outpatients or for early discharge.
Patients with non-severe CAP must be managed as outpatients. Our finding demonstrate that carefully evaluated patients with more severe CAP (severeal RFs) can be safely managed as outpatients or discharged early from the hospital. This could reduce the burden of economic costs and the risk of developing complications related to hospitalization, especially in the elderly people.
J. Brea Folco, None.