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Respiratory infection
Comparison of clinical characteristics and performance of pneumonia severity score and CURB-65 among younger adults, elderly and very old subjects
  1. Jung-Hsiang Chen1,2,
  2. Shy-Shin Chang2,3,
  3. Jason J Liu4,
  4. Rai-Chi Chan5,6,
  5. Jiunn-Yih Wu3,
  6. Wei-Chuan Wang5,6,
  7. Si-Huei Lee5,6,7,
  8. Chien-Chang Lee4,8
  1. 1Department of Family Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
  2. 2Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
  3. 3Department of Family Medicine and Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
  4. 4Department of Epidemiology, Harvard School of Public Health, Boston, USA
  5. 5Department of Rehabilitation and Physical Medicine, National Yang-Ming University, Taipei, Taiwan
  6. 6Department of Rehabilitation and Physical Medicine, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan
  7. 7Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan
  8. 8Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
  1. Correspondence to Si-Huei Lee, Department of Rehabilitation and Physical Medicine, Taipei Veterans General Hospital, No 201, Sec 2, Shipai Road, Taipei 112, Taiwan; sihuei.lee{at}gmail.com Or Chien-Chang Lee, Department of Emergency Medicine, National Taiwan University Hospital, No 7, ChungShan South Road, Taipei 100, Taiwan; cclee100{at}gmail.com

Abstract

Background Age-related alterations in the clinical characteristics and performance of severity scoring systems for community-acquired pneumonia (CAP) are unknown.

Methods Consecutive patients with CAP presenting to the emergency department were prospectively studied. Patients were classified as younger adults (age 18–64 years), elderly (age 65–84 years) and very old subjects (age ≥85 years). Clinical characteristics, complications, outcomes and validity of the pneumonia severity index (PSI) and CURB-65 categories were compared across these three age categories.

Results Analysis involved 348 (35.3%) younger adult patients, 438 (44.3%) elderly patients and 201 (20.0%) very old patients. Compared with younger adults, elderly and very old patients had a higher burden of comorbidities and a higher incidence of CAP-related complications. The 30-day mortality rate was 5.2% in younger adults, 7.1% in elderly patients and 9.5% in very old patients. The area under the ROC curve (AUCs) for PSI were 0.87 (95% CI 0.77 to 0.97), 0.85 (95% CI 0.803 to 0.897) and 0.69 (95% CI 0.597 to 0.787) and the AUCs for CURB-65 were 0.80 (95% CI 0.67 to 0.93), 0.73 (95% CI 0.65 to 0.82) and 0.60 (95% CI 0.47 to 0.73) in the younger adult, elderly and very old patients, respectively. A modified PSI or CURB-65 excluding the age variable increased the AUC in most age categories. There was no significant effect of age on 30-day mortality after adjusting for other PSI or CURB-65 variables.

Conclusion Elderly patients with CAP have more atypical clinical manifestations and worse outcomes. The underperformance of the PSI in elderly patients may be due to the inappropriate weight given to the age variable. A modification of the cut-off point for PSI or CURB-65 to define severe pneumonia may improve the score performance in elderly patients.

  • Community-acquired pneumonia
  • very old
  • elderly
  • pneumonia severity index
  • CURB-65
  • area under the ROC curve
  • clinical epidemiology
  • pneumonia

https://doi.org/10.1136/thx.2009.129627

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    Footnotes

    • Linked articles 138131.

    • Funding This work is supported by grant NSC 97-2321-B-002-014 from the National Science Council of Taiwan.

    • Competing interests None.

    • Patient consent Obtained.

    • Ethics approval This study was conducted with the approval of the Institutional Review Board, National Taiwan University Hospital.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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