Is pneumonia really the old man's friend? Two-year prognosis after community-acquired pneumonia

Abstract

SummaryIs pneumonia "the old man's friend"—a terminal event for patients who will otherwise die soon of underlying chronic disease? If so, chronological age might influence treatment policy. We investigated the predictors of 2-year mortality after patients' admission to hospital for community-acquired pneumonia, and focused on the predictive value of age. In a prospective cohort study 141 consecutive patients were admitted to hospital with community-acquired pneumonia. Clinical, laboratory, and sociodemographic data were collected on admission. Comorbidity was categorised as mild, moderate, or severe by a physician based on the patient's medical history. Survival was assessed at 24 months after discharge. 22 (16%) patients died in hospital. Of the remaining 119, 38 (32%) died over the next 24 months. In a Cox model, 2-year mortality was independently related to severe comorbidity (relative risk [RR]=9·4) or moderate comorbidity (RR=3·1), and to haematocrit less than 35% (RR=2·9) (all p≤0·005). However, compared with patients aged 18-44 years, patients aged 45-64 (RR=0·84), 65-74 (RR=1·28), and 75-92 (RR=1·99) were not significantly more likely to die during the 24 months after discharge (all p≥0·2). Old age should not be a sole criterion for withholding aggressive treatment of community-acquired pneumonia.