Review of bacteraemia in elderly patients in a District General Hospital in the United Kingdom

Abstract

Objective.– To determine the value of procalcitonin (PCT) as a prognostic biomarker in elderly patients with respiratory infection comparing it with Curb-65 and acute phase reactants: C-reactive protein (CRP), erythrocyte sedimentation rate (ESR)and leukocytes. Methods.– Prospective observational study in elderly patients admitted to an Acute Geriatric Unit with the diagnosis of upper respiratory infection or pneumonia. We collected sociodemographic variables, clinical and geriatric assessment. Samples were taken to determine PCT, CRP and ESR at admission and 72hours after. Results.– We included 50 patients, 30 with pneumonia and 20 with respiratory infection, with an average age of 86 years, significant comorbidity (Charlson Index≥3 in more than 50%), cognitive impairment (70%) and poor functional status (Katz≥D 56%). Mortality during admission was high (37% in pneumonia and 25% in upper respiratory infection). At admission 60% of patients have elevated PCT (≥0.25ng/mL), 100% PCR, 84% ESR and 36% leukocytes. In all patients the PCT difference between admission and 72hours was marginal (P=0.059); in patients with respiratory infection decreased significantly at 72hours (P=0.046),while there wasnovariation inpatientswithpneumonia. Theother acutephase reactants, except leukocytes (P≤0.05) showedno significant differences during the first 72hours. Conclusions.– In elderly patients with suspected upper respiratory infection, decreased procalcitonin levels at 72hours indicates a good prognosis. In those with pneumonia study these evolutionary parameters at 72hours show no change, so control should be delayed.