Walking ability as a prognostic indicator in elderly patients with community-acquired pneumonia: a retrospective...

Community-acquired pneumonia is a leading cause of mortality among the elderly, and traditional severity scores may not fully apprehend functional vulnerability. This study evaluated whether pre-morbid walking ability predict 28-day mortality in elderly pneumonia patients.

This retrospective multicenter observational study included patients aged ≥ 65 years diagnosed with community-acquired pneumonia at two emergency departments between 2018 and 2019. Patients with comorbidities affecting walking ability, as stroke, cognitive disorders, malignancy, were excluded. To evaluate the predictive performance of walking ability and clinical variables for 28-day mortality, multivariable logistic and Cox regression analyses were performed. For calculation of area under the curve of variables and severity scores, receiver operating characteristic analysis was used.

Of 428 patients, the median age was 77 years, 377 patients (88.1%) could walk independently, and 33 (7.7%) expired in 28 days. In logistic regression, female gender, albumin, and lactate-to-albumin ratio were independent predictors. The prediction model combining inability to walk and lactate-to-albumin ratio showed an area under the curve of 0.793, superior to CURB-65 (0.658, p = 0.026). In Cox analysis, inability to walk remained independent predictor associated with 28-day mortality.

In patients ≥ 65 years with community-acquired pneumonia, inability to walk with lactate-to-albumin ratio demonstrated better discriminative performance for 28-day mortality than CURB-65 and inability to walk remained independently associated with 28-day mortality after adjustment. This simple combined assessment can serve as a practical adjunct to existing severity scores when triaging elderly patients and considering the need for higher-intensive care.