Epidemiological and clinical management aspects of pneumonias diagnosed in the emergency department in elderly patients in Spain: Results of the EDEN-29 study

Abstract

Objectives

To estimate the incidence of pneumonia diagnosis in elderly patients in Spanish emergency departments (ED), need for hospitalization, adverse events and predictive capacity of biomarkers commonly used in the ED.

Methods

Patients ≥65 years with pneumonia seen in 52 Spanish EDs were included. We recorded in-hospitaland 30-day mortality as adverse events, as well as intensive care unit (ICU) admission among hospitalizedpatients. Association of 10 predefined variables with adverse events was calculated and expressed as odds ratio (OR) with 95% confidence interval (CI), as well as predictive capacity of 5 commonly used biomarkers in the ED (leukocytes, hemoglobin, C-reactive protein, glucose, creatinine) was investigated using area under the receiver operating characteristic curve (AUC-ROC).

Results

591 patients with pneumonia attended in the ED were included (annual incidence of 18,4 per 1000 inhabitants). A total of 78.0% were hospitalized. Overall, 30-day mortality was 14.2% and in-hospital mortality was 12.9%. Functional dependency was associated with both events (OR = 4.453, 95%CI = 2.361–8.400; and OR = 3.497, 95%CI = 1.578–7.750, respectively) as well as severe comorbidity (2.344, 1.363–4.030, and 2.463, 1.252–4.846, respectively). Admission to the ICU during hospitalization occurred in 3.5%, with no associated factors. The predictive capacity of biomarkers was only moderate for creatinine for ICU admission (AUC-ROC = 0.702, 95% CI = 0.536–0.869) and for leukocytes for post-discharge adverse event (0.669, 0.540–0.798).

Conclusions

Pneumonia is a frequent diagnosis in elderly patients consulting in the ED. Their functional dependence and comorbidity is the factor most associated with adverse events. The biomarkers analyzed do not have a good predictive capacity for adverse events.

Resumen

Objetivos

Estimar la incidencia de diagnóstico de neumonía en pacientes mayores en los servicios de urgencias (SU) españoles, necesidad de hospitalización, eventos adversos y capacidad predictiva de biomarcadores.

Métodos

Se incluyeron pacientes de ≥65 años con neumonía atendidos en 52 SUespañoles. Como eventos adversos, se recogió mortalidad intrahospitalaria y a los 30 días, ingreso en unidad de cuidados intensivos (UCI). Se calcularon las odds ratio (OR) ajustadas con su intervalo de confianza del 95% (IC95%) de estos eventos y se investigó la capacidad predictiva de 5 biomarcadores de uso habitual en urgencias (leucocitos, hemoglobina, proteína-C reactiva, glucosa, creatinina) mediante área bajo la curva de la característica operativa del receptor (ABC-COR).

Resultados

Se incluyeron 591 pacientes con neumonía (incidencia anual de 18,4 por 1000 habitantes). El 78,0% fue hospitalizado. La mortalidad global a 30 días fue del 14,2% y la intrahospitalaria del 12,9%. La dependencia funcional se asoció a ambos eventos (OR = 4,453, IC95% = 2,361–8,400; y OR = 3,497, IC95% = 1,578–7,750, respectivamente) así como la comorbilidad grave (2,344, 1,363–4,030, y 2,463, 1,252–4,846, respectivamente). El ingreso en UCI durante la hospitalización aconteció en el 3,5%. La capacidad predictiva de los biomarcadores solo resultó moderada para creatinina para ingreso en UCI (ABC-COR = 0,702, IC 95% = 0,536–0,869) y para leucocitos para evento adverso post-alta (0,669, 0,540–0,798).

Conclusiones

La neumonía es un diagnóstico frecuente en los pacientes mayores que consultan en SU. Su situación basal, especialmente dependencia funcional y comorbilidad, es el factor que más se asocia a eventos adversos. Los biomarcadores analizados no tienen buena capacidad individual predictiva de eventos adversos.