Community-acquired pneumonia requiring hospitalization in the elderly. Clinical features and prognosis.

We evaluated retrospectively 96 patients older than 64 years admitted with the diagnosis of Community Acquired Pneumonia (CAP) in order to describe th e clinical features, evaluate severity and assess prognostic factors. Durin g an 18-month period 100 cases of GAP were included. Average age was 82.3 y ears +/- 8.3 (+/- SD). By the time of admission, cough and fever were found in 35% of cases and 48% had altered mental status. Fourteen per cent neede d mechanical ventilation. Etiology was determined in 21% of cases. Most com mon pathogens were S. pneumoniae (38.1%), S. aureus (19%) and H infuenzae ( 14.3%). Overall mortality was 29%. The most commonly present criteria of se verity were tachypnea (respiratory rate > 30) and a PaO2/FIO2 ratio < 250. Severe pneumonia was found in 60% of patients and mortality in that group w as 40%. Multivariate analysis demonstrated that some independent prognostic factors were associated with higher mortality: requirement of vasopressors (Odds Ratio [OR] = 22.0; 95% confidence interval [GI] = 1.9-249.5), oligur ia (OR = 9.9; CI = 1.5-66.2), previous neurologic disease (OR = 8.2; CI = 1 .8-36.6), PaCO2 > 44 mm/Hg (OR = 6.9; CI = 1.1-43.2), and creatinine > 1.4 mg/dl (OR = 4.7; CI = 1.2-19.1). We conclude that CAP features in elderly p atients requiring hospitalization are atypical, severe presentations are fr equent and mortality is high. Prognostic factors as found in this study can help the evaluating physician to identify those who require special care.