Factors influencing prognosis of pneumonia in elderly patients.

Background and aims: Polymorbidity reduces the survival of elderly patients with pneumonia. The aim of the proposed study was to identify factors determining mortality in such patients. Methods: From January 1, 1999 to December 31, 2001, 2870 patients were admitted to the Clinic of Geriatric Medicine, Faculty of Medicine, Comenius University, Bratislava. From these, 199 patients treated for pneumonia (average age ±SD 79.7±7.6 yr) were assigned to a retrospective study. 112 patients recovered and 87 died. The prognostic significance of the chosen factors was evaluated by comparing their incidence between the groups of surviving and non-surviving patients. Results: Prognosis for patients with pneumonia is worsened significantly by: older age; immobilization syndrome; incontinence of urine and feces; presence of some clinical and laboratory characteristics at the time of diagnosis of pneumonia (respiratory insufficiency, absence of fever, leukocytosis); pneumonia acquired in hospital; immunosuppressive therapy and comorbid conditions (congestive heart failure, chronic renal insufficiency, anemia, hepatic, psychiatric and neoplastic diseases). According to multivariate analysis, the most significant mortality-predicting characteristics were: immobilization (odds ratio (OR) 9.36; 95% confidence interval (CI) 3.92-22.33); congestive heart failure (OR 8.26; 95% CI 3.08-22.14); immunosuppressive therapy (OR 7.47; 95% CI 2.54–21.98) and psychiatric diseases (OR 4.53; 95% CI 1.94–10.58). Conclusions: Patients with immobilization, congestive heart failure, immunosuppressive therapy, or psychiatric diseases run a high risk of death and require intensive medical care.