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.

Blood Pressure Health

Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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