Defining prognostic factors in the elderly with community acquired pneumonia: a case controlled study of patients...

Severity assessment in the elderly with community acquired pneumonia (CAP) may be different compared with younger patients. In particular, age per se may not be of prognostic significance in older patients. A case-control study in 158 patients aged > or = 75 yrs with CAP was conducted to determine the factors associated with in-hospital mortality. Cases were drawn from all patients aged > or = 75 yrs with CAP who died in 1997 in five hospitals in the mid-Trent region of the UK (Nottingham City Hospital, University Hospital Nottingham, Derby Royal Infirmary, Derby City General Hospital and Kings Hill Hospital). Controls were randomly selected from survivors also aged > or = 75 yrs. Factors associated with mortality were identified following a review of the medical casenotes and the contribution of these factors to mortality was determined using multivariate analysis. Absence of fever, tachycardia and chest radiograph features of bilateral involvement or an effusion were independently associated with mortality on multivariate analysis. The British Thoracic Society (BTS) severity rule was 50% sensitive and 64% specific in predicting death while the modified BTS rule displayed 67% sensitivity and 58% specificity. Age was not significantly associated with mortality in this group of patients aged > or = 75 yrs. Similarly, the clinical features employed in the British Thoracic Society rule, namely respiratory rate, diastolic blood pressure and blood urea, were not of prognostic significance and the rule itself performed poorly. The modified British Thoracic Society rule performed better.