Diagnostic accuracy of activities of daily living in prediction of community-acquired pneumonia outcomes in elderly patients admitted to intensive care units

Abstract

Background/PurposeMost severity scores can predict severe community acquired pneumonia (CAP) and its associated poor outcomes. The impact of baseline functional status on the prediction of the outcome of CAP remains controversial. Therefore, we aimed to detect the diagnostic accuracy of the baseline function using activities of daily living (ADL) in prediction of mechanical ventilation (MV) and 30-day mortality and to compare its diagnostic accuracy with the CURB-65 and SCAP scores in patients with CAP. MethodsA prospective cohort study was conducted on 65 patients aged ≥60 years presenting with CAP and admitted consecutively to geriatric and chest intensive care units in Ain Shams University Hospitals from October 2011 to June 2012. Patients were subjected to assessment of the severity of CAP using the CURB-65 and SCAP scores, and for baseline function using the ADL score. Follow-up for MV and 30-day mortality was also done. ResultsThe mean age of the patients was 69.9 ± 11.4 years; 40% of patients died, 41.5% were on MV, and 75.4% had ADL score ≤ 3 points. By logistic regression, the ADL score was found to be an independent predictor for mortality and MV in patients with CAP after adjusting for confounding factors. Using ADL score for prediction of mortality and MV was best at cut off ≤ 3, which revealed area under the curve (AUC) = 0.705, 0.679; p = 0.005, 0.015; sensitivity = 100%, 96.3%; specificity = 41% and 39.5%, respectively. Pairwise comparison between AUCs of the ADL score and other scores revealed no significant difference. ConclusionThe ADL score can be an attractive alternative to conventional indices as it is an independent predictor for mortality and MV in patients with CAP.