Risk factors for 30-day mortality in elderly patients with lower respiratory tract infection. Community-based study

Pneumonia is a major cause of death in the elderly, but there are few studies of risk factors for death that include both ambulatory and nursing home patients.

To assess factors associated with 30-day mortality in a population-based study of older adults with lower respiratory tract infection.

Identification of (1) a previously identified retrospective cohort of all residents of Rochester, Minn, aged 65 years or older who experienced a first episode of pneumonia or bronchitis during a calendar year and (2) the risk factors associated with 30-day mortality through review of complete inpatient and ambulatory medical records. Logistic regression was used to identify significant independent risk factors for 30-day mortality.

A total of 413 adults aged 65 years or older were identified. The independent factors for 30-day mortality were atypical symptoms (odds ratio [OR], 4.98; 95% confidence interval [CI], 2.14-11.60), neurologic illness (OR, 3.92; 95% CI, 1.47-6.59), current diagnosis of cancer (OR, 6.2; 95% CI, 2.40-15.99), and recent or current use of antibiotics (OR, 3.13; 95% CI, 1.45-6.77).

Malignancy and neurologic disease are well-recognized conditions that identify patients with lower respiratory tract infections who have a high risk of death within 30 days. An atypical presentation with confusion, lethargy, poor eating, or recent or current antibiotic use also identifies patients, with a high risk of 30-day mortality.