Prognosis of Primary Care Patients Aged 80 Years and Older with Lower Respiratory Tract Infection

Overview

Journal Br J Gen Pract

Specialty Public Health

Date 2009 Apr 4

PMID 19341546

Citations 8

Authors

Christiana van de Nadort

Hugo M Smeets

Jettie Bont

N Peter A Zuithoff

Eelko Hak

Theo J M Verheij

Affiliations

Soon will be listed here.

Abstract

Background: Predictors for a complicated course of a lower respiratory tract infection (LRTI) episode among patients aged > or =80 years are unknown.

Aim: To determine prognostic factors for hospital admission or death within 30 days after first onset of LRTI among primary care patients aged > or =80 years.

Design Of Study: Retrospective cohort study.

Setting: Utrecht General Practitioner Research Network.

Method: Data were obtained using the computerised database of the research network over the years 1997 to 2003. Multivariable logistic regression analysis was applied to estimate the independent association of predictors with 30-day hospitalisation or death.

Results: In all, 860 episodes of LRTI were observed in 509 patients; 13% of patients were hospitalised or died within 30 days. Type of LRTI, diabetes, use of oral glucocorticoids, use of antibiotics in the previous month, and hospitalisation in the previous 12 months were independently associated with the combined outcome. Patients with insulin-dependent diabetes mellitus had a greater risk of 30-day hospitalisation or death compared with patients with non-insulin-dependent diabetes.

Conclusion: Independent of age, serious comorbidity - notably the presence of insulin-dependent diabetes or exacerbation of chronic obstructive pulmonary disease requiring oral glucocorticoids - increases the risk for complications, including hospital admissions, in patients aged > or =80 years with an LRTI.

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References

Houston M, Silverstein M, Suman V . Risk factors for 30-day mortality in elderly patients with lower respiratory tract infection. Community-based study. Arch Intern Med. 1997; 157(19):2190-5. View

Fine M, Auble T, Yealy D, Hanusa B, Weissfeld L, Singer D . A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997; 336(4):243-50. DOI: 10.1056/NEJM199701233360402. View

Riquelme R, Torres A, de la Bellacasa J, Estruch R, Mensa J, Fernandez-Sola J . Community-acquired pneumonia in the elderly: A multivariate analysis of risk and prognostic factors. Am J Respir Crit Care Med. 1996; 154(5):1450-5. DOI: 10.1164/ajrccm.154.5.8912763. View

Myint P, Kamath A, Vowler S, Maisey D, Harrison B . The CURB (confusion, urea, respiratory rate and blood pressure) criteria in community-acquired pneumonia (CAP) in hospitalised elderly patients aged 65 years and over: a prospective observational cohort study. Age Ageing. 2004; 34(1):75-7. DOI: 10.1093/ageing/afh234. View

MacFarlane J, Holmes W, Gard P, Macfarlane R, Rose D, Weston V . Prospective study of the incidence, aetiology and outcome of adult lower respiratory tract illness in the community. Thorax. 2001; 56(2):109-14. PMC: 1746009. DOI: 10.1136/thorax.56.2.109. View

Seppa Y, Bloigu A, Honkanen P, Miettinen L, Syrjala H . Severity assessment of lower respiratory tract infection in elderly patients in primary care. Arch Intern Med. 2001; 161(22):2709-13. DOI: 10.1001/archinte.161.22.2709. View

Fonarow G . Epidemiology and risk stratification in acute heart failure. Am Heart J. 2008; 155(2):200-7. DOI: 10.1016/j.ahj.2006.10.043. View

Lim W, Macfarlane J . Defining prognostic factors in the elderly with community acquired pneumonia: a case controlled study of patients aged > or = 75 yrs. Eur Respir J. 2001; 17(2):200-5. DOI: 10.1183/09031936.01.17202000. View

Farr B, Sloman A, Fisch M . Predicting death in patients hospitalized for community-acquired pneumonia. Ann Intern Med. 1991; 115(6):428-36. DOI: 10.7326/0003-4819-115-6-428. View

10.

Hak E, Buskens E, van Essen G, de Bakker D, Grobbee D, Tacken M . Clinical effectiveness of influenza vaccination in persons younger than 65 years with high-risk medical conditions: the PRISMA study. Arch Intern Med. 2005; 165(3):274-80. DOI: 10.1001/archinte.165.3.274. View

11.

Hak E, Bont J, Hoes A, Verheij T . Prognostic factors for serious morbidity and mortality from community-acquired lower respiratory tract infections among the elderly in primary care. Fam Pract. 2005; 22(4):375-80. DOI: 10.1093/fampra/cmi020. View

12.

Zeger S, Liang K . Longitudinal data analysis for discrete and continuous outcomes. Biometrics. 1986; 42(1):121-30. View

13.

Hak E, Rovers M, Kuyvenhoven M, Schellevis F, Verheij T . Incidence of GP-diagnosed respiratory tract infections according to age, gender and high-risk co-morbidity: the Second Dutch National Survey of General Practice. Fam Pract. 2006; 23(3):291-4. DOI: 10.1093/fampra/cmi121. View

14.

Loeb M . Pneumonia in older persons. Clin Infect Dis. 2003; 37(10):1335-9. DOI: 10.1086/379076. View

15.

Hak E, Wei F, Nordin J, Mullooly J, Poblete S, Nichol K . Development and validation of a clinical prediction rule for hospitalization due to pneumonia or influenza or death during influenza epidemics among community-dwelling elderly persons. J Infect Dis. 2004; 189(3):450-8. DOI: 10.1086/381165. View

16.

Pachon J, PRADOS M, Capote F, Cuello J, Garnacho J, Verano A . Severe community-acquired pneumonia. Etiology, prognosis, and treatment. Am Rev Respir Dis. 1990; 142(2):369-73. DOI: 10.1164/ajrccm/142.2.369. View

17.

Ewig S, Bauer T, Hasper E, Pizzulli L, Kubini R, Luderitz B . Prognostic analysis and predictive rule for outcome of hospital-treated community-acquired pneumonia. Eur Respir J. 1995; 8(3):392-7. DOI: 10.1183/09031936.95.08030392. View

18.

Fine M, Orloff J, Arisumi D, Fang G, Arena V, Hanusa B . Prognosis of patients hospitalized with community-acquired pneumonia. Am J Med. 1990; 88(5N):1N-8N. View

19.

Farr B, BARTLETT C, Wadsworth J, Miller D . Risk factors for community-acquired pneumonia diagnosed upon hospital admission. British Thoracic Society Pneumonia Study Group. Respir Med. 2000; 94(10):954-63. DOI: 10.1053/rmed.2000.0865. View

20.

Shah B, Hux J . Quantifying the risk of infectious diseases for people with diabetes. Diabetes Care. 2003; 26(2):510-3. DOI: 10.2337/diacare.26.2.510. View