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Risk and Prognostic Factors in Very Old Patients with Sepsis Secondary to Community-Acquired Pneumonia.

ABSTRACT: Little is known about risk and prognostic factors in very old patients developing sepsis secondary to community-acquired pneumonia (CAP). Methods: We conducted a retrospective observational study of data prospectively collected at the Hospital Clinic of Barcelona over a 13-year period. Consecutive patients hospitalized with CAP were included if they were very old (≥80 years) and divided into those with and without sepsis for comparison. Sepsis was diagnosed based on the Sepsis-3 criteria. The main clinical outcome was 30-day mortality. Results: Among the 4219 patients hospitalized with CAP during the study period, 1238 (29%) were very old. The prevalence of sepsis in this age group was 71%. Male sex, chronic renal disease, and diabetes mellitus were independent risk factors for sepsis, while antibiotic therapy before admission was independently associated with a lower risk of sepsis. Thirty-day and intensive care unit (ICU) mortality did not differ between patients with and without sepsis. In CAP-sepsis group, chronic renal disease and neurological disease were independent risk factors for 30-day mortality. Conclusion: In very old patients hospitalized with CAP, in-hospital and 1-year mortality rates were increased if they developed sepsis. Antibiotic therapy before hospital admission was associated with a lower risk of sepsis.

SUBMITTER: Cilloniz C

PROVIDER: S-EPMC6678833 | biostudies-literature | 2019 Jul

REPOSITORIES: biostudies-literature

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Risk and Prognostic Factors in Very Old Patients with Sepsis Secondary to Community-Acquired Pneumonia.

Cillóniz Catia C Dominedò Cristina C Ielpo Antonella A Ferrer Miquel M Gabarrús Albert A Battaglini Denise D Bermejo-Martin Jesús J Meli Andrea A García-Vidal Carolina C Liapikou Adamanthia A Singer Mervyn M Torres Antoni A

Journal of clinical medicine 20190702 7

<h4>Background</h4>Little is known about risk and prognostic factors in very old patients developing sepsis secondary to community-acquired pneumonia (CAP). <b>Methods:</b> We conducted a retrospective observational study of data prospectively collected at the Hospital Clinic of Barcelona over a 13-year period. Consecutive patients hospitalized with CAP were included if they were very old (≥80 years) and divided into those with and without sepsis for comparison. Sepsis was diagnosed based on the ...[more]

PMID: 31269766

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Project description:BackgroundQuick Sepsis-related Organ Failure Assessment (qSOFA) is a new screening system for sepsis. The prognostic performance of qSOFA for patients with suspected infections outside the intensive care unit (ICU) is similar to that of full SOFA; however, its performance for community-acquired pneumonia (CAP) has not yet been evaluated in detail.The objectives of the present study were to compare the prognostic performance of qSOFA with existing pneumonia severity scores, such as CURB-65 (confusion, blood urea nitrogen > 19 mg/dL, respiratory rate ≥ 30/min, systolic blood pressure < 90 mmHg, or diastolic blood pressure ≤ 60 mmHg, age ≥ 65 years) and the pneumonia severity index (PSI), and examine its usefulness for predicting mortality and ICU admission in patients with CAP of high severity and mortality that requires hospitalization.MethodsWe performed a secondary analysis of data from a prospective observational study of adult patients who were admitted to our hospital between October 2010 and June 2016. We compared the prognostic performance of qSOFA, CURB-65, and PSI for predicting in-hospital mortality and ICU admission using the C statistics.ResultsThe median age of the 1045 enrolled patients was 77 (68-83) years, and 71.4% were males. The in-hospital mortality and ICU admission rates of the entire cohort were 6.1 and 7.9%, respectively. All scores were significantly higher in non-survivors and ICU admission patients than in survivors and non-ICU admission patients (p < 0.001). The C statistics of qSOFA for predicting in-hospital mortality was 0.69 (95% CI 0.63-0.75), and no significant differences were observed between CURB-65 (C statistics, 0.75; 95% CI 0.69-0.81) and PSI (C statistics, 0.74; 95% CI 0.69-0.80). The C statistics of qSOFA for predicting ICU admission was 0.76 (95% CI 0.71-0.80), and no significant differences were noted between CURB-65 (C statistics, 0.73; 95% CI 0.67-0.79) and PSI (C statistics, 0.72; 95% CI 0.66-0.78).ConclusionsRegarding hospitalized CAP, the prognostic performance of qSOFA for in-hospital mortality and ICU admission was not significantly different from those of CURB-65 and PSI. qSOFA only requires a few items and vital signs, and, thus, may be particularly useful for emergency department or non-respiratory specialists.

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Risk and Prognostic Factors in Very Old Patients with Sepsis Secondary to Community-Acquired Pneumonia.

Publications

Risk and Prognostic Factors in Very Old Patients with Sepsis Secondary to Community-Acquired Pneumonia.

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