Epidemiological and clinical management aspects of pneumonias diagnosed in the emergency department in elderly patients in Spain: Results of the EDEN-29 study.

Autor: Cuerpo S; Área de Urgencias, Hospital Clínico, IDIBAPS, Universidad de Barcelona, Barcelona, Spain., Aguiló S; Área de Urgencias, Hospital Clínico, IDIBAPS, Universidad de Barcelona, Barcelona, Spain., Poblete-Palacios MF; Área de Urgencias, Hospital Clínico, IDIBAPS, Universidad de Barcelona, Barcelona, Spain., Burillo-Putze G; Servicio de Urgencias, Hospital Universitario de Canarias, Tenerife, Spain., Alquézar-Arbé A; Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain., Jacob J; Servicio de Urgencias, Hospital Universitario de Bellvitge, l'Hospitalet de Llobregat, Barcelona, Spain., Fernández C; Servicio de Urgencias, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain., Llorens P; Servicio de Urgencias, Unidad de Estancia Corta y Hospitalización a Domicilio, Hospital Doctor Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain., Montero-Pérez FJ; Servicio de Urgencias, Hospital Reina Sofía, Córdoba, Spain., Iglesias-Frax C; Servicio de Urgencias, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain., Quero-Motto E; Servicio de Urgencias, Hospital Universitario Virgen Arrixaca, Murcia, Spain., Escudero-Sánchez C; Servicio de Urgencias, Hospital Universitario Lorenzo Guirao, Cieza, Murcia, Spain., Poch-Ferrer EA; Servicio de Urgencias, Hospital Doctor Trueta, Girona, Spain., Hong-Cho JU; Servicio de Urgencias, Hospital de Mendaro, Gipuzkoa, Spain., Casado-Ramón B; Servicio de Urgencias, Hospital Miguel Servet, Zaragoza, Spain., Gayoso-Martín S; Servicio de Urgencias, Hospital Comarcal El Escorial, Madrid, Spain., Sánchez-Sindín G; Servicio de Urgencias, Hospital do Salnés, Villagarcía de Arousa, Pontevedra, Spain., Fernández-Álvarez ME; Servicio de Urgencias, Hospital de Barbanza, Ribeira, A Coruña, Spain., Puiggali-Ballard M; Servicio de Urgencias, Hospital del Mar, Barcelona, Spain., Trejo O; Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain., Llauger L; Servicio de Urgencias, Hospital Universitari de Vic, Barcelona, Spain., Garrido-Acosta L; Servicio de Urgencias, Hospital del Nalón, Langreo, Asturias, Spain., Calle-Fernández S; Servicio de Urgencias, Hospital Virgen de Altagracia, Manzanares, Ciudad Real, Spain., Molina L; Servicio de Urgencias, Hospital Nuestra Señora del Prado, Talavera de la Reina, Toledo, Spain., Martínez-Juan M; Servicio de Urgencias, Hospital del Vinalopó, Elche, Alicante, Spain., Gómez-García G; Servicio de Urgencias, Hospital de Mósteles, Madrid, Spain., Rivas Del Valle P; Servicio de Urgencias, Hospital Virgen del Rocío, Sevilla, Spain., López-Grima ML; Servicio de Urgencias, Hospital Doctor Peset, Valencia, Spain., Rull-Bertrán P; Servicio de Urgencias, Hospital Universitari Son Espases, Palma de Mallorca, Spain., González Del Castillo J; Servicio de Urgencias, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain., Miró Ò; Servicio de Urgencias, Hospital Universitario de Canarias, Tenerife, Spain. Electronic address: omiro@clinic.cat.
Jazyk: angličtina
Zdroj: Enfermedades infecciosas y microbiologia clinica (English ed.) [Enferm Infecc Microbiol Clin (Engl Ed)] 2024 Oct; Vol. 42 (8), pp. 420-429. Date of Electronic Publication: 2024 Feb 22.
DOI: 10.1016/j.eimce.2023.10.007
Abstrakt: Objectives: To estimate the incidence of pneumonia diagnosis in elderly patients in Spanish emergency departments (ED), need for hospitalization, adverse events and predictive capacity of biomarkers commonly used in the ED.
Methods: Patients ≥65 years with pneumonia seen in 52 Spanish EDs were included. We recorded in-hospitaland 30-day mortality as adverse events, as well as intensive care unit (ICU) admission among hospitalizedpatients. Association of 10 predefined variables with adverse events was calculated and expressed as odds ratio (OR) with 95% confidence interval (CI), as well as predictive capacity of 5 commonly used biomarkers in the ED (leukocytes, hemoglobin, C-reactive protein, glucose, creatinine) was investigated using area under the receiver operating characteristic curve (AUC-ROC).
Results: 591 patients with pneumonia attended in the ED were included (annual incidence of 18,4 per 1000 inhabitants). A total of 78.0% were hospitalized. Overall, 30-day mortality was 14.2% and in-hospital mortality was 12.9%. Functional dependency was associated with both events (OR=4.453, 95%CI=2.361-8.400; and OR=3.497, 95%CI=1.578-7.750, respectively) as well as severe comorbidity (2.344, 1.363-4.030, and 2.463, 1.252-4.846, respectively). Admission to the ICU during hospitalization occurred in 3.5%, with no associated factors. The predictive capacity of biomarkers was only moderate for creatinine for ICU admission (AUC-ROC=0.702, 95% CI=0.536-0.869) and for leukocytes for post-discharge adverse event (0.669, 0.540-0.798).
Conclusions: Pneumonia is a frequent diagnosis in elderly patients consulting in the ED. Their functional dependence and comorbidity is the factor most associated with adverse events. The biomarkers analyzed do not have a good predictive capacity for adverse events.
(Copyright © 2023 Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. Published by Elsevier España, S.L.U. All rights reserved.)
Databáze: MEDLINE
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