Performance status and in-hospital mortality of elderly patients with community acquired pneumonia

Abstract

To evaluate the role of performance status evaluated by the Eastern Cooperative Oncology Group (ECOG) score in predicting 30-day mortality in subjects hospitalized for community acquired pneumonia (CAP), this was a prospective study of patients consecutively hospitalized for CAP at a large University Hospital in Italy. Performance status was evaluated using the ECOG score that in a 0-5 point scale indicates progressive functional deterioration. The end-point of the study is the 30-day mortality. Two-hundred-sixteen patients were enrolled, 75.9% were aged > 70 years, 31.5% had severe pneumonia at CURB-65 score (3-4), and 27.5% of patients had severe disability (ECOG 3-4). Thirty-day mortality is 15.3%. Progression in ECOG score independently increases the probability of 30-day mortality at multivariable logistic regression analysis (HR 2.19, 95% CI 1.60-3.01, p < 0.0001). ECOG 3 or 4 determines a four-fold increase in 30-day mortality (HR 4.07, 95% CI 1.84-9.02, p < 0.001). ECOG score 3 or 4 is highly predictive of death in patients classified at low risk of mortality by CURB-65 (0-2 points) score. Functional status is directly related to outcome in elderly patients hospitalized for CAP. The use of a very simple and fast tool, such as the ECOG score, might help to better stratify the risk of short-term mortality, especially in patients otherwise classified at low risk of death by CURB-65 score.

Development and validation of a new scoring system for prognostic prediction of community-acquired pneumonia in older adults

“…However, this index would be unsuitable in daily clinical practice because of the large number of variables to be evaluated and the complex calculation involved. Conversely, the Eastern Cooperative Oncology Group (ECOG) score, a simpler tool developed for functional evaluation in patients with cancer, was shown to be useful for predicting the prognosis of patients with CAP, even when limited to older adults 18 , 28 . In this study, an ECOG score of 4 (i.e., bedridden state) was a significant prognostic factor.…”

Characteristics and Management of Community-Acquired Pneumonia in the Era of Global Aging

“…Several studies on CAP in different parts of the world have reported that Streptococcus pneumoniae (pneumococcus) remains the leading cause of pneumonia in the elderly population [ 2 , 71 , 72 , 73 , 74 ]. In the study by Cilloniz et al [ 2 ] of the impact of age on the microbial etiology of CAP, pneumococcus was the most frequently reported microorganism in all age groups, as follows: 41% in the 65–74 years old group, 39% in the 75–84 years old group, and 49% in the >85 years old group.…”

“…Two European studies on nursing home patients with CAP found the etiology to be similar to that reported in CAP patients [ 71 , 74 ]. However, clinicians should carefully consider the presence of specific risk factors associated with multidrug-resistant pathogens such as prior antibiotic therapy, chronic pulmonary disease, admission to a nursing home and prior hospitalization [ 72 , 75 , 76 , 77 ] ( Table 3 ).…”

Mortality prediction using clinical and laboratory features in elderly patients with severe community-acquired pneumonia

“…The management of SCAP in elderly patients is often challenging, and risk stratification may be helpful to guide clinical decision making. Several recent studies have suggested that the mortality of elderly patients with SCAP is influenced by complex interactions among factors such as age, gender, tachycardia, effusions, and functional status (11)(12)(13).…”