Lower incidence of acute respiratory distress syndrome in community-acquired pneumonia patients aged 85 years or older
| Autor: | Mariko Yamazaki, Yasunari Tsuda, Ayumi Toba, Hideaki Mochizuki, Eriko Kawate, Toshiyuki Noguchi, Yohei Suzuki, Hideki Takahashi |
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| Rok vydání: | 2010 |
| Předmět: |
Pulmonary and Respiratory Medicine
Male medicine.medical_specialty ARDS Pneumonia severity index Aspiration pneumonia Community-acquired pneumonia Risk Factors Internal medicine medicine Humans Intensive care medicine Aged Retrospective Studies Aged 80 and over Respiratory Distress Syndrome business.industry Incidence (epidemiology) Mortality rate Incidence Age Factors Pneumonia medicine.disease Systemic inflammatory response syndrome Community-Acquired Infections Acute Disease Female business |
| Zdroj: | Respirology (Carlton, Vic.). 15(2) |
| ISSN: | 1440-1843 |
| Popis: | Clinical variables and laboratory data were compared to elucidate the risk factors associated with the development of ARDS among elderly patients with community-acquired pneumonia (CAP). The predictors for ARDS appeared to differ from the determinants of severity of CAP. ARDS developed less frequently among patients agedor=85 years.The incidence of and risk factors for ARDS among elderly patients with community-acquired pneumonia (CAP) have not been well characterized.The clinical details of 221 consecutive patients agedor=65 years, who were admitted with CAP during the period April 2006 to June 2008, were investigated by review of patient charts. Clinical variables and laboratory data at admission for CAP were compared between patients with and without ARDS.Eighteen patients (8.1%) developed ARDS 1-5 days after admission. The mortality rate was 44% in patients with ARDS and 10.3% in those without ARDS (P0.001). The incidence of ARDS was 8.5-20% among patients aged85 years and 1.1% in patients agedor=85 years (P0.001), while overall mortality rates were not significantly different among the age groups. Predictors for the development of ARDS included higher serum levels of CRP and glucose, lower PaO2/fraction of inspired O2 (FiO2), PaCO2 and HCO3-, and the presence of systemic inflammatory response syndrome at admission. ARDS developed less frequently among patients with pneumonia associated with oropharyngeal aspiration (AP). Multivariate analysis indicated that lower age, serum glucose, pre-existence of systemic inflammatory response syndrome and non-oropharyngeal AP were significant risk factors for ARDS. The Pneumonia Severity Index and confusion, urea, respiratory rate, blood pressure, ageor=65 score were not correlated with the incidence of ARDS.Predictors for ARDS appeared to differ from the determinants of severity of CAP in the elderly. ARDS developed less frequently in patients agedor=85 years and in those with oropharyngeal AP. It is important to identify subjects at high risk for ARDS upon admission and to observe them closely. |
| Databáze: | OpenAIRE |
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