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

Lancet. 1993 Jul 3;342(8862):30-3. doi: 10.1016/0140-6736(93)91887-r.

Abstract

Is 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 < or = to 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 > or = to 0.2). Old age should not be a sole criterion for withholding aggressive treatment of community-acquired pneumonia.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Comorbidity
  • Female
  • Follow-Up Studies
  • Hematocrit
  • Hospital Mortality
  • Hospitalization
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Pneumonia / microbiology
  • Pneumonia / mortality*
  • Pneumonia / therapy*
  • Probability
  • Prognosis
  • Prospective Studies
  • Risk
  • Socioeconomic Factors
  • Survival Rate