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Vol. 38. Issue 2.
Pages 67-71 (February 2002)
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Vol. 38. Issue 2.
Pages 67-71 (February 2002)
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Neumonía adquirida en la comunidad en el anciano. Factores pronósticos
Community-acquired pneumonia in the elderly: prognostic factors
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M.G. Clemente
, T.G. Budiño, G.A. Seco, M. Santiago, M. Gutiérrez, P. Romero
Sección de Neumologí1a. Hospital Álvarez-Buylla. Mieres. Asturias
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La incidencia de la neumonía adquirida en la comunidad (NAC) en el anciano y su mortalidad es muy superior con respecto a la población joven. Sin embargo, esto puede explicarse por la presencia de comorbilidad concomitante más que por la edad por sí sola. Nosotros realizamos un estudio retrospectivo de 226 pacientes de edad superior a 65 años que fueron ingresados en nuestro hospital con el diagnóstico de NAC durante un período de 36 meses con el fin de valorar factores pronósticos de mortalidad en este grupo de población y describir, asimismo, las características clínicas. La edad media fue de 78,71 (límites 65–96) años. Un total de 142 pacientes fueron varones (63%) y 84 mujeres (37%). En el momento del ingreso, el 27,4% de los pacientes presentaban alteración del estado mental. La mortalidad cruda fue del 20,8%. El análisis multivariante demostró algunos factores de riesgo independientes asociados con mayor mortalidad: creatinina sérica > 1,2mg/dl (riesgo relativo [RR]: 13,93; in-tervalo de confianza [IC] 95%: 8,14–16,08), encamamiento previo (RR: 5,73; IC del 95%: 3,41–6,79), PaO2 /FiO2 < 200 (RR: 5; IC del 95%: 2,67–6,62) y enfermedad neoplásica (RR: 4,08; IC del 95%: 1,96–5,24). La presencia de dolor torácico se asoció con un riesgo menor de mortalidad (RR: 0,11; IC del 95%: 0,01–0,54). La edad por sí sola no fue un factor de riesgo relacionado con el pronóstico. Concluimos que la neumonía en el anciano que requiere hospitalización se presenta en muchas ocasiones con clínica severa y alta mortalidad. Los factores pronósticos como los objetivados en este estudio pueden ayudar al clínico a evaluar aquellos pacientes que requieren cuidados especiales

Palabras clave:
Mortality
risk factors
Pneumonia
community-acquired
features
Elderly

The incidence and mortality rates of community-acquired pneumonia are far higher in the elderly than among younger populations. However, the explanation may lie in the presence of comorbidity rather than in age itself. We performed a retrospective study of 226 patients over the age of 65 years who were admitted to our hospital with a diagnosis of community-acquired pneumonia over a period of 36 months, with the objective of identifying factors predicting mortality and to describe clinical features. The patients' mean age was 78.71 (65–96) years. One hundred forty-two were men (63%) and 84 were women (37%). Upon admission, 27.4% showed signs of altered mental state. The crude mortality rate was 20.8%. Multivariate analysis demonstrated the following independent risk factors associated with higher mortality: serum creatinine > 1.2mg/dL (RR=13.93; 95% CI 8.14–16.08); patient previously bedridden (RR=5.73; 95% CI 3.41–6.79), PaO2 /FiO2 < 200 (RR=5; 95% CI 2.67–6.62) and neoplastic disease (RR=4.08; 95% CI 1.96–5.24). The presence of chest pain was associated with a lower risk of mortality (RR=0.11; 95% CI 0.01–0.54). Age itself was not a risk factor. We conclude that pneumonia in the elderly requires hospitalization and that it commonly presents with severe symptoms and high risk of mortality. Risk factors such as those identified in this study may help in the diagnosis and treatment of patients requiring special care

Keywords:
Factores pronósticos de mortalidad
Neumonía adquirida en la comunidad
Clínica de la neumonía adquirida en la comunidad en el anciano
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Copyright © 2002. Sociedad Española de Neumología y Cirugía Torácica
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