Prognostic Indicators and Outcome

Items associated with a higher risk of in-hospital or 30-day mortality for older patients hospitalized with pneumonia are NHAP vs. CAP, bedridden status, altered mental status, absence of fever (<37° C), absence of cough or chills, tachypnea (RR > 30/min), systemic hypotension (SBP < 90 mmHg), respiratory failure, CRP > 100mg/L, multilobar involvement, pleural effusion, radiological signs of cavitation, suspicion of aspiration, presence of swallowing disorders, hypo-albuminemia, hyper-phosphoremia, renal failure, liver disease, and Gramnegative pneumonia (Janssens et al., 2004).

Factors associated with a prolonged length of hospital stay are age, delirium, NHAP vs. CAP, roentgeno-grams suggestive of aspiration, cyanosis, leucocytosis, and presence of band forms in blood smears (Janssens et al., 2004).

Hospitalization for CAP is associated with a high rate of readmission (53-62%) and a high mortality in the year following discharge (24-41%) (Kaplan et al., 2002; Bohannon et al., 2004; Torres et al., 2004). Aspiration pneumonia and total number of comorbidities were identified as predictive of readmission within a year of discharge. In the large study by Kaplan et al. (2003), 1-year mortality increased from 29% for patients without comorbidities to 57% in patients with >3 comorbidities. Factors reported as significantly related to death were Barthel Index scores (quantifying dependence in activities of daily life), peripheral muscle strength (handgrip), and absolute number of comorbidities.

A recent French prospective case-control study focused on risk factors for nosocomial pneumonia (NP) in a geriatric hospital; 75 cases were identified, with a complication rate of 58% and a 12% mortality (Rothan-Tondeur et al., 2003). Most significant risk factors for NP were prior NP, oxygen therapy, NGT feeding, and malnutrition.

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