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Original Article
Available online 30 September 2022
Validation of IDSA/ATS Guidelines for ICU Admission in Adults Over 80 Years Old With Community-Acquired Pneumonia
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Catia Cilloniza,b,
Corresponding author
catiacilloniz@yahoo.com

Corresponding authors.
, Miquel Ferrera, Juan M. Pericàsc,d, Leyre Serranoe,f, Raúl Méndezg, Albert Gabarrúsa, Héctor José Peronih, Luis Alberto Ruize, Rosario Menéndezg, Rafael Zalacaine, Antoni Torresa,
Corresponding author
atorres@clinic.cat

Corresponding authors.
a Pneumology Department, Respiratory Institute, Hospital Clinic of Barcelona – Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB) – SGR 911 – Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (Ciberes), Barcelona, Spain
b Facultad de Ciencias de la Salud, Universidad Continental, Huancayo, Perú
c Infectious Disease Department, Hospital Clínic of Barcelona, Spain
d Liver Unit, Internal Medicine Department, Vall d’Hebron University Hospital, Vall d’Hebron Institute for Research, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
e Pulmonology Department, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
f Immunology, Microbiology and Parasitology Department, School of Medicine and Nurse, University of the País Vasco/Euskal Herriko Unibertsitatea UPV/EHU, Leioa, Bizkaia, Spain
g Pulmonology Department, Hospital La Fe in Valencia, Valencia, Spain
h Internal Medicine Department, Respiratory Medicine Unit and Emergency Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
Received 20 June 2022. Accepted 18 August 2022
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Abstract
Introduction

The 2007 IDSA/ATS guidelines for community-acquired pneumonia (CAP) recommended intensive care unit (ICU) admission for adults meeting severe CAP criteria. We aimed to validate the accuracy of IDSA/ATS criteria in patients80 years old (very elderly patients, VEP) with CAP.

Methods

Prospective cohort study of VEP with CAP admitted to three Spanish hospitals between 1996 and 2019. We compared patients who did and did not require ICU admission. We also assessed factors independently associated with ICU admission, as well as the accuracy of severe CAP criteria for ICU admission and mortality. Major criteria include septic shock and invasive mechanical ventilation while minor criteria encompass other variables related to hemodynamics and respiratory insufficiency as well as level of consciousness, renal function, blood parameters indicative of sepsis and body temperature.

Results

Of the 2006 VEP with CAP, 519 (26%) met severe CAP criteria, while 204 (10%) required ICU admission. Concordance between severe CAP criteria and the decision to admit the patient to the ICU occurred in 1591 (79%) cases (k coefficient, 0.33), with a sensitivity of 75% and specificity of 80% in predicting ICU admission. All patients with invasive mechanical ventilation received care in ICUs, while 45 (44%) patients with septic shock—previously stabilized in the emergency room—did not. Thirty-day mortality of ICU-admitted patients with septic shock was lower than that of patients in wards (30% vs. 60%, p=0.013). In contrast, patients with severe CAP and only minor criteria had similar mortality.

Conclusions

IDSA/ATS criteria for severe CAP predict ICU admission in VEP moderately well. While patients with septic shock and invasive mechanical ventilation warrant ICU admission, severe CAP without major severity criteria in VEP may be acceptably manageable in wards.

Keywords:
Community-acquired pneumonia
Severity scores
Elderly
Mayor and minor ATS/IDSA criteria

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