A New Prognosis Score to Predict Mortality After Acute Pneumonia in Very Elderly Patients

Abstract

ObjectivesAcute pneumonia (AP) induces an excess of mortality among the elderly. We evaluated the value of a new predictive biomarker index compared to usual prognosis scores for predicting in-hospital and 1-year mortalities in elderly inpatients with AP. DesignRetrospective study in 6 clinical departments of a university hospital. SettingBurgundy university hospital (France). ParticipantsAll patients aged 75 and over with AP and hospitalized between January 1 and June 30, 2013, in the departments of medicine (5) and intensive care (1) of our university hospital. MeasurementsA new index, which we named UBMo, was created by multiplying the uremia (U in the formula) by the N-terminal–pro-brain natriuretic peptide (NT-proBNP) plasmatic rate (B), divided by the monocyte count (Mo). ResultsAmong the 217 patients included, there were 138 community-acquired pneumonia, 56 nursing home–acquired pneumonia, and 23 hospital-acquired pneumonia. In-hospital and 1-year mortality rates were respectively 19.8% and 43.8%. In multivariate analysis, Pneumonia Severity Index (PSI), unlike CURB-65 (confusion, urea >7 mmol/L, respiratory rate ≥30 breaths/min, blood pressure <90 mmHg systolic or ≤60 mmHg diastolic, age ≥65) score, was associated with in-hospital and 1-year mortalities. UBMo index performed better than PSI and CURB-65 scores in predicting both in-hospital and 1-year mortalities. For in-hospital mortality, the areas under the receiver operating characteristic curves (AUCs) were 0.89 (95% CI = 0.84–0.94), 0.72 (95% CI = 0.65–0.80), and 0.63 (95% CI = 0.54–0.72), respectively, for the 3 scores. For 1-year mortality, the AUCs were 0.93 (95% CI = 0.89–0.98), 0.66 (95% CI = 0.59–0.74), and 0.58 (95% CI = 0.50–0.66), respectively, for the 3 scores. The cut point for the UBMo index of 20,000 × 10−9 ng·mmol/L had a sensitivity of 93.1% and 80.9% and a specificity of 76.3% and 95.8%, respectively, for in-hospital and 1-year mortalities. ConclusionIf confirmed by prospective studies, the UBMo index appears very efficient in identifying patients at high risk of in-hospital and 1-year mortalities after an AP.