A prediction rule for elderly primary-care patients with lower respiratory tract infections

Abstract

Prognostic scores for lower respiratory tract infections (LRTI) have been mainly derived in a hospital setting. The current authors have developed and validated a prediction rule for the prognosis of acute LRTI in elderly primary-care patients.Data including demographics, medication use, healthcare use and comorbid conditions from 3,166 episodes of patients aged o65 yrs visiting the general practitioner (GP) with LRTI were collected. Multiple logistic regression analysis was used to construct a predictive model. The main outcome measure was 30-day hospitalisation or death. The Second Dutch Survey of GPs was used for validation.The following were independent predictors of 30-day hospitalisation or death: increasing age; previous hospitalisation; heart failure; diabetes; use of oral glucocorticoids; previous use of antibiotics; a diagnosis of pneumonia; and exacerbation of chronic obstructive pulmonary disease. A prediction rule based on these variables showed that the outcome increased directly with increasing scores: 3, 10 and 31% for scores of ,2 points, 3-6 and o7 points, respectively. Corresponding figures for the validation cohort were 3, 11 and 26%, respectively. This simple prediction rule can help the primary-care physician to differentiate between highand low-risk patients. As a possible consequence, low-risk patients may be suitable for home treatment, whereas high-risk patients might be monitored more closely in a homecare or hospital setting. Future studies should assess whether information on signs and symptoms can further improve this prediction rule.

Prognosis of primary care patients aged 80 years and older with lower respiratory tract infection

“…Data from a large cohort of older patients with LRTI, used by Bont et al, 22 were analysed. The data originated from the database of the Utrecht GP Research Network.…”

“…[7][8][9][10][11][12][14][15][16][17]21,22,[24][25][26] Age, sex, current use of medication, comorbidity, and healthcare use in the previous 12 months, including hospitalisation and GP visits, were regarded as potential predictors. Current use of medication was defined as medication prescribed on the day of diagnosis and ≥1 week prior to that day.…”

“…[7][8][9]15,20,21 In a recent study from the authors' group in which a prediction rule was developed for older primary care patients with LRTI aged ≥65 years, it was shown that age was an independent predictor of clinical outcome. 22 However, older patients, for example, those aged ≥80 years, were not analysed separately. The prognosis of this subgroup is relevant because the number of older patients is increasing rapidly and their complications are relatively severe.…”

The International Primary Care Respiratory Group (IPCRG) Research Needs Statement 2010

“…285 Clinical prediction rules to determine high and low risk elderly patients show promise in assisting primary care clinicians to decide who may be managed at home and who need closer monitoring or hospital care. 286,287 Morbidity and mortality from respiratory infections are greater in patients with co-morbidities such as COPD, asthma, diabetes, renal failure, alcohol abuse, and immunosuppression. 288,289 Smokers are prescribed antibiotics more frequently than non-smokers, with no apparent benefit.…”

A transgenic mouse with vascular endothelial over-expression of the non-muscle myosin light chain kinase-2 isoform is susceptible to inflammatory lung injury: role of sexual dimorphism and age

“…In this study, we report the role of the nmMLCK2 splice variant in vascular barrier regulation, and we describe the consequences of overexpressing this isoform specifically in murine endothelium. Furthermore, as several acute and chronic inflammatory pulmonary disorders, which include ALI and acute respiratory distress syndrome (ARDS), are influenced by gender, [ 13 ], [ 14 ], [ 15 ], [ 16 ], [ 17 ], [ 18 ], [ 19 ], [ 20 ], [ 21 ] and [ 22 ] age, [ 23 ], [ 24 ], [ 25 ], [ 26 ] and [ 27 ] or gender-age interactions, [ 28 ], [ 29 ] and [ 30 ] we designed our study to evaluate the influence of these comodifiers on postulated nmMLCK2-mediated increases in vascular paracellular transport. This is supported by findings in mice, which like humans, have varying respiratory properties that differ between sexes [ 31 ], [ 32 ] and [ 33 ] and with age, [ 34 ] and [ 35 ] information often neglected when describing a pulmonary phenotype.…”