Disease burden and prognostic factors for clinical failure in elderly community acquired pneumonia patients

Xiudi Han,Guangqiang Wang,Yimin Wang,Xiaojing Cui,Xin Xing ,Lijuan Li,Chunxiao Zhang,Guohua Yu,Ying Xiao,Hao Yu ,Xiaoli Zhu,Lei Wang,Meng Li ,Fei Zhou,Bo Liu,Xuexin Yao,Jinxiang Wang,Yanli Li,Xuedong Liu,Liang Chen,Chunxue Xue,Hui Li,Lijun Suo,Bin Cao

doi:10.1186/s12879-020-05362-3

Abstract

BackgroundThe study was to evaluate initial antimicrobial regimen and clinical outcomes and to explore risk factors for clinical failure (CF) in elderly patients with community-acquired pneumonia (CAP).Methods3011 hospitalized elderly patients were enrolled from 13 national teaching hospitals between January 1, 2014 and December 31, 2014 initiated by the CAP-China network. Risk factors for CF were screened by multivariable logistic regression analysis.ResultsThe incidence of CF in elderly CAP patients was 13.1%. CF patients were older, longer hospital stays and higher treatment costs than clinical success (CS) patients. The CF patients were more prone to present hyperglycemia, hyponatremia, hypoproteinemia, pleural effusion, respiratory failure and cardiovascular events. Inappropriate initial antimicrobial regimens in CF group were significantly higher than CS group. Undertreatment, CURB-65, PH < 7.3, PaO2/FiO2 < 200 mmHg, sodium < 130 mmol/L, healthcare-associated pneumonia, white blood cells > 10,000/mm3, pleural effusion and congestive heart failure were independent risk factors for CF in multivariable logistic regression analysis. Male and bronchiectasis were protective factors.ConclusionsDiscordant therapy was a cause of CF. Early accurate detection and management of prevention to potential causes is likely to improve clinical outcomes in elderly patients CAP.Trial registrationA Retrospective Study on Hospitalized Patients With Community-acquired Pneumonia in China (CAP-China) (RSCAP-China), NCT02489578. Registered 16 March 2015, https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0005E5S&selectaction=Edit&uid=U0000GWC&ts=2&cx=1bnotb

Highlights

The study was to evaluate initial antimicrobial regimen and clinical outcomes and to explore risk factors for clinical failure (CF) in elderly patients with community-acquired pneumonia (CAP)
CF occurred in 13.1% of elderly patients, 220 patients (55.7%) were early failure
The rates of congestive heart failure (CHF), bronchiectasis, cerebral vascular disease and chronic renal disease were significantly higher in CF patients

Summary

Introduction

The study was to evaluate initial antimicrobial regimen and clinical outcomes and to explore risk factors for clinical failure (CF) in elderly patients with community-acquired pneumonia (CAP). Lower respiratory tract infections (LRTIs) fell to 4th place of global causes of deaths worldwide in 2016, yet community-acquired pneumonia (CAP) remains a leading cause of morbidity and mortality for hospitalization in LRTIs patients, especially for patients aged ≥65 years [1,2,3]. After initiation of empirical antibiotic therapy, patients with CAP can experience different clinical outcomes, clinical improvement, clinical failure (CF) and non-resolving pneumonia. Of which, underlying comorbidity [10, 11], severity of illness [10, 12] and antimicrobial regimen [13, 14] were independent factors for mortality of elderly hospitalized CAP. CF and mortality are the most relevant outcomes in elderly patients with CAP, yet there is rare discussion in literatures about its incidence and etiology

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Discussion

Conclusion