A Comparative Study of Clinical and Paraclinical Findings of Elderly and Non-Elderly Patients With Acute Pneumonia and Pneumosepsis
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Abstract
Accurate diagnosis and timely treatment of pneumonia, as one of the most common infectious diseases in elderly patients, require careful attention to the clinical and paraclinical findings, which may be different between the elderly and non-elderly patients. The aim of the present study was to compare the clinical, laboratory, and radiological findings of elderly and non-elderly patients with pneumonia and pneumosepsis. This cross-sectional study was performed on 97 elderly and 93 non-elderly patients with pneumonia, admitted to Sina hospital in Hamadan, west of Iran, in 2017. Patients in both groups were also compared in terms of the underlying diseases, sepsis rate, electrolyte disturbances and CURB-65 criteria. All underlying diseases, except for HIV infection, in addition to clinical findings such as tachypnea, lethargy, decreased consciousness, hypotension, and respiratory alkalosis were significantly more common in the elderly, compared to the non-elderly group. In the elderly group, the average length of hospital stay, sepsis rate, and mortality rate were 9.4 days, 74.2%, and 21.7%, respectively versus 6.2 days, 46.3%, and 3.2%, respectively in the non-elderly group. Patients in the two groups were significantly different in terms of CkkURB-65 criteria and radiological findings. For the timely diagnosis of pneumonia and pneumosepsis in the elderly, it is necessary to consider any alteration in respiratory rate and consciousness status. Also, for proper treatment, the clinicians should pay attention to the existence of any comorbidities and electrolyte disturbances.
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7. Norman DC, Yoshikawa TT. Fever in the elderly. Infectious disease clinics of North America. 1996;10(1):93-9.
8. Rowe TA, McKoy JM. Sepsis in older adults. Infectious disease clinics of North America. 2017;31(4):731-42.
9. Almirall J, Bolibar I, Balanzo X, Gonzalez CA. Risk factors for community-acquired pneumonia in adults: A population-based case-control study. The European respiratory journal. 1999;13(2):349-55.
10. Faverio P, Aliberti S, Bellelli G, Suigo G, Lonni S, Pesci A, et al. The management of community-acquired pneumonia in the elderly. European journal of internal medicine. 2014;25(4):312-9.
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17. Chong CP, Street PR. Pneumonia in the elderly: A review of the epidemiology, pathogenesis, microbiology, and clinical features. Southern medical journal. 2008;101(11):1141-5; quiz 32, 79.
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19. Momen Hervi M, Afsali H. Common infections in elderly people admitted to the infectious ward of Shaheed Beheshti Hospital in Kashan. Salmand. 2012;6(2):62-70.
20. Pieralli F, Vannucchi V, Mancini A, Grazzini M, Paolacci G, Morettini A, et al. Delirium is a predictor of in-hospital mortality in elderly patients with community acquired pneumonia. Internal and emergency medicine. 2014;9(2):195-200.
21. Lopardo G, Basombrio A, Clara L, Desse J, De Vedia L, Di Libero E, et al. [Guidelines for management of community-acquired pneumonia in adults].Medicina. 2015;75(4):245-57.
22. Harison MT, Kiady R, Rasoafaranirina MO. Peculiarities of Community-Acquired Pneumonia in elderly patients seen in the department of infectious disease at Befelatanana University Hospital; Antananarivo Madagascar. Averroes Eur Med J. 2017;6(2):1-9.
23. Ahkee S, Srinath L, Ramirez J. Community-acquired pneumonia in the elderly: Association of mortality with lack of fever and leukocytosis. Southern medical journal. 1997;90(3):296-8.
24. Fernandez-Sabe N, Carratala J, Roson B, Dorca J, Verdaguer R, Manresa F, et al. Community-acquired pneumonia in very elderly patients: causative organisms, clinical characteristics, and outcomes. Medicine. 2003;82(3):159-69.
25. Simonetti AF, Viasus D, Garcia-Vidal C, Carratala J. Management of community-acquired pneumonia in older adults. Therapeutic advances in infectious disease. 2014;2(1):3-16.
26. Palmu AA, Saukkoriipi A, Snellman M, Jokinen J, Torkko P, Ziegler T, et al. Incidence and etiology of community-acquired pneumonia in the elderly in a prospective population-based study. Scandinavian journal of infectious diseases. 2014;46(4):250-9.
27. Matsuno O, Kataoka H, Takenaka R, Okubo F, Okamoto K, Masutomo K, et al. Influence of age on symptoms and laboratory findings at presentation in patients with influenza-associated pneumonia. Archives of gerontology and geriatrics. 2009;49(2):322-5.
28. Ahmadi F, Roozbeh F. [Infections leading to admission in elderly and non- elderly groups in a referral teaching hospital]. J Mazandaran Univ Med Sci. 2013;23(105):117-20.
29. Martin S, Perez A, Aldecoa C. Sepsis and immunosenescence in the elderly patient: A review. Frontiers in medicine. 2017;4:20.
30. Green JE, Ariathianto Y, Wong SM, Aboltins C, Lim K. Clinical and inflammatory response to bloodstream infections in octogenarians. BMC geriatrics. 2014;14:55.
31. Feldman C. Pneumonia in the elderly. The Medical clinics of North America. 001;85(6):1441-59.
32. Tipping B, De Villiers L. Pneumonia in the elderly-diagnosis and treatment in general practice. South African Family Practice. 2006;48(5):24-8.
2. Htwe TH, Mushtaq A, Robinson SB, Rosher RB, Khardori N. Infection in the elderly. Infectious disease clinics of North America. 2007;21(3):711-43, ix.
3. Cools HJ, van der Meer JW. [Infections and aging]. Ned Tijdschr Geneesk. 998;142(41):2242-5.
4. Warshaw G, Mehdizadeh S, Applebaum RA. Infections in nursing homes: Assessing quality of care. The journals of gerontology Series A, Biological sciences and medical sciences. 2001;56(2):M120-3.
5. Uslan DZ, Crane SJ, Steckelberg JM, Cockerill FR, 3rd, St Sauver JL, Wilson WR, et al. Age- and sex-associated trends in bloodstream infection: A population-based study in Olmsted County, Minnesota. Archives of internal medicine. 2007;167(8):834-9.
6. Fung HB, Monteagudo-Chu MO. Community-acquired pneumonia in the elderly. The American journal of geriatric pharmacotherapy. 2010;8(1):47-62.
7. Norman DC, Yoshikawa TT. Fever in the elderly. Infectious disease clinics of North America. 1996;10(1):93-9.
8. Rowe TA, McKoy JM. Sepsis in older adults. Infectious disease clinics of North America. 2017;31(4):731-42.
9. Almirall J, Bolibar I, Balanzo X, Gonzalez CA. Risk factors for community-acquired pneumonia in adults: A population-based case-control study. The European respiratory journal. 1999;13(2):349-55.
10. Faverio P, Aliberti S, Bellelli G, Suigo G, Lonni S, Pesci A, et al. The management of community-acquired pneumonia in the elderly. European journal of internal medicine. 2014;25(4):312-9.
11. Mandell LA, Wunderink R. Pneumonia. In: Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J, editors. Harrisons principles of internal medicine. 19th ed: Mc Graw-Hill; 2015. p. 803-13.
12. Stupka JE, Mortensen EM, Anzueto A, Restrepo MI. Community-acquired pneumonia in elderly patients. Aging health. 2009;5(6):763-74.
13. Palomba H, Correa TD, Silva E, Pardini A, Assuncao MS. Comparative analysis of survival between elderly and non-elderly severe sepsis and septic shock resuscitated patients. Einstein. 2015;13(3):357-63.
14. Kang CI, Song JH, Ko KS, Chung DR, Peck KR, The Asian Network for Surveillance of Resistant Pathogens (ANSORP) Study Group. Clinical features and outcome of Staphylococcus aureus infection in elderly versus younger adult patients. International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases. 2011;15(1):e58-62.
15. Sharifi-Mood B, Metanat M. Spectrum of clinical infectious diseases in hospitalized elderly patients in the southeast of Iran. Turk J Med Sci. 2007;37(4):213-7.
16. Vila-Corcoles A, Ochoa-Gondar O, Rodriguez-Blanco T, Raga-Luria X, Gomez-Bertomeu F, Group ES. Epidemiology of community-acquired pneumonia in older adults: A population-based study. Respiratory medicine. 2009;103(2):309-16.
17. Chong CP, Street PR. Pneumonia in the elderly: A review of the epidemiology, pathogenesis, microbiology, and clinical features. Southern medical journal. 2008;101(11):1141-5; quiz 32, 79.
18. Wawruch M, Krcmery S, Bozekova L, Wsolova L, Lassan S, Slobodova Z, et al. Factors influencing prognosis of pneumonia in elderly patients. Aging clinical and experimental research. 2004;16(6):467-71.
19. Momen Hervi M, Afsali H. Common infections in elderly people admitted to the infectious ward of Shaheed Beheshti Hospital in Kashan. Salmand. 2012;6(2):62-70.
20. Pieralli F, Vannucchi V, Mancini A, Grazzini M, Paolacci G, Morettini A, et al. Delirium is a predictor of in-hospital mortality in elderly patients with community acquired pneumonia. Internal and emergency medicine. 2014;9(2):195-200.
21. Lopardo G, Basombrio A, Clara L, Desse J, De Vedia L, Di Libero E, et al. [Guidelines for management of community-acquired pneumonia in adults].Medicina. 2015;75(4):245-57.
22. Harison MT, Kiady R, Rasoafaranirina MO. Peculiarities of Community-Acquired Pneumonia in elderly patients seen in the department of infectious disease at Befelatanana University Hospital; Antananarivo Madagascar. Averroes Eur Med J. 2017;6(2):1-9.
23. Ahkee S, Srinath L, Ramirez J. Community-acquired pneumonia in the elderly: Association of mortality with lack of fever and leukocytosis. Southern medical journal. 1997;90(3):296-8.
24. Fernandez-Sabe N, Carratala J, Roson B, Dorca J, Verdaguer R, Manresa F, et al. Community-acquired pneumonia in very elderly patients: causative organisms, clinical characteristics, and outcomes. Medicine. 2003;82(3):159-69.
25. Simonetti AF, Viasus D, Garcia-Vidal C, Carratala J. Management of community-acquired pneumonia in older adults. Therapeutic advances in infectious disease. 2014;2(1):3-16.
26. Palmu AA, Saukkoriipi A, Snellman M, Jokinen J, Torkko P, Ziegler T, et al. Incidence and etiology of community-acquired pneumonia in the elderly in a prospective population-based study. Scandinavian journal of infectious diseases. 2014;46(4):250-9.
27. Matsuno O, Kataoka H, Takenaka R, Okubo F, Okamoto K, Masutomo K, et al. Influence of age on symptoms and laboratory findings at presentation in patients with influenza-associated pneumonia. Archives of gerontology and geriatrics. 2009;49(2):322-5.
28. Ahmadi F, Roozbeh F. [Infections leading to admission in elderly and non- elderly groups in a referral teaching hospital]. J Mazandaran Univ Med Sci. 2013;23(105):117-20.
29. Martin S, Perez A, Aldecoa C. Sepsis and immunosenescence in the elderly patient: A review. Frontiers in medicine. 2017;4:20.
30. Green JE, Ariathianto Y, Wong SM, Aboltins C, Lim K. Clinical and inflammatory response to bloodstream infections in octogenarians. BMC geriatrics. 2014;14:55.
31. Feldman C. Pneumonia in the elderly. The Medical clinics of North America. 001;85(6):1441-59.
32. Tipping B, De Villiers L. Pneumonia in the elderly-diagnosis and treatment in general practice. South African Family Practice. 2006;48(5):24-8.
| Files | ||
| Issue | Vol 57, No 8 (2019) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/acta.v57i8.2427 | |
| Keywords | ||
| Elderly patients Pneumonia Sepsis Clinical presentations | ||
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How to Cite
1.
Majzoobi MM, Jalalvand Z, Khanlarzadeh E, Moradi A. A Comparative Study of Clinical and Paraclinical Findings of Elderly and Non-Elderly Patients With Acute Pneumonia and Pneumosepsis. Acta Med Iran. 2020;57(8):503-509.
