Chest Infections |

Early Mortality in Very Elderly Patients With Non-Hospital Acquired Pneumonia: Causes and Risk Factors FREE TO VIEW

Jae Seok Park, MD; Yeong June Jeon, MD
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Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea

Chest. 2013;144(4_MeetingAbstracts):255A. doi:10.1378/chest.1704337
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SESSION TITLE: Infections in Older Patients

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Sunday, October 27, 2013 at 04:15 PM - 05:15 PM

PURPOSE: Pneumonia is one of the leading causes of death in elderly. A number of risk factors may influence mortality in very elderly patients with pneumonia, and some of the factors associated with early mortality may differ from those associated with mortality occurring later. The aim of this study was to evaluate the causes and factors related with early mortality in very elderly hospitalized patients with non-hospital acquired pneumonia (NHAP).

METHODS: We performed a retrospective study of all hospital death patients ≥80 yr age admitted with diagnosis of NHAP in single center between June 2007 and May 2012. Clinical data obtained included demographic characteristics, comorbid conditions, laboratory investigation, microbiological data, chest radiographic findings, pneumonia severity index (PSI) and CURB-65 pneumonia severity score. Early deaths, defined as death due to any cause of death ≤48 h after admission, were compared with late deaths (patients who died >48 h). Univariate and multivariate regression analysis were performed to identify risk factors for early mortality.

RESULTS: A total of 76 NHAP patients were included in this study period. Twenty-one patients (27.6%) died ≤48 h after admission. Overall, mean hospital day was 12.63±22.16. The main causes of early mortality were septic shock/multiorgan failure (57.1%%). Factors associated with early mortality were bedridden status before admission, PSI class V, vasopressor at admission and nursing home care. After adjustment for covariates, we found that PSI class V (OR, 9.968; p=0.033) and nursing home care (OR, 4.461; p=0.024) were independent factors associated with early mortality.

CONCLUSIONS: This study suggests that PSI class V and nursing home care may be useful predictors of early mortality in very elderly non-hospital acquired pneumonia patients.

CLINICAL IMPLICATIONS: Identification of patients at high risk for early death may help decision for intensive care and end-of-life care in this group of patients.

DISCLOSURE: The following authors have nothing to disclose: Jae Seok Park, Yeong June Jeon

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