SEVERE COMMUNITY-ACQUIRED PNEUMONIA IN THE ELDERLY - EPIDEMIOLOGY ANDPROGNOSIS

Ninety-five patients with severe community-acquired pneumonia (SCAP) w ho were greater than or equal to 65 years of age were studied prospect ively. A definite pathogen was identified in 37 cases (38.9%) and was most commonly Streptococcus pneumoniae, Haemophilus influenzae, or ano ther gram-negative bacillus. The overall death rate was 40%, Eighty-th ree patients required mechanical ventilation and 40 needed vasoactive drugs, Multivariate analysis showed that the risk of death was higher in cases involving rapid radiological spread (relative risk [RR] = 6.9 9; 95% confidence interval (95% CI) = 1.54-31.70), shock (RR = 6.70; 9 5% CI = 2.13-21.02), previous steroid treatment or immunosuppression ( RR = 5.50; 95% CI = 0.77-39.10), acute renal failure (RR = 3.88; 95% C I = 1.30-11.59), or an APACHE II score of >22 on admission (RR = 2.25; 95% CI = 0.73-6.95). We conclude that SCAP in elderly patients is ass ociated with high mortality, but it is inappropriate to withhold inten sive care on account of age. The presence of complications and the sev erity of illness at initial presentation were the major variables affe cting outcome. Except for immunosuppression, comorbidities did not see m to influence outcome. Finally, our data reinforce the current Americ an Thoracic Society guidelines concerning therapy for patients with SC AP.