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Severity Assessment of Lower Respiratory Tract Infection in Elderly Patients in Primary Care
Yrjö Seppä, MD;
Aini Bloigu, BSc;
Pekka O. Honkanen, MD, PhD;
Liisa Miettinen, MD;
Hannu Syrjälä, MD, PhD
Arch Intern Med. 2001;161:2709-2713.
Background Simple markers for evaluating the severity of lower respiratory tract
infections (LRTI) in primary care are lacking. It is of value to examine whether
the information available to the primary care physician during a patient's
initial visit can be used to assess the severity of LRTI.
Methods The associations between different baseline variables and outcomes (survival
within or more than 30 days) were investigated prospectively in a series of
950 home-living patients 65 years or older with severe LRTI that their primary
care physicians suspected to be pneumonia.
Results Twenty-one men and 17 women died (4.1%) within 30 days. According to
univariate analysis, the following parameters differed (P<.01) between the fatalities and survivors: acute aggravation of
a coexisting illness, age, respiratory rate, white blood cell count, and C-reactive
protein (CRP) level. According to Cox forward stepwise regression analysis
(P = .01 for entry and .05 for removal), acute aggravation
of a concurrent illness, respiratory rate ( 25/min), and CRP concentration
(100 mg/L) were independently associated with death. The mortality rate
was 2.2% if the patients had none or only 1 of the independent risk factors
and 20% if they had all 3 risk factors.
Conclusions Preceding aggravation of a concurrent illness and respiratory rate of
25/min or higher, together with an elevated serum CRP level (100 mg/L),
can be used as simple markers for identifying patients with the highest risk
for LRTI and improve management decisions among elderly people in primary
care.
From the Department of Infection Control, Oulu University Hospital,
Oulu (Drs Seppä and Syrjälä); the National Public Health Institute,
Oulu (Ms Bloigu); the Department of Public Health Science and General Practice,
University of Oulu, Oulu (Dr Honkanen); Oulu University Hospital, Oulu, and
Oulaskangas Hospital, Oulainen (Dr Miettinen); and Kemi Health Center, Kemi
(Dr Honkanen), Finland.
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