title: Community-acquired pneumonia in older veterans: does the pneumonia prognosis index help?
abstract: OBJECTIVE
  Mortality rates from pneumonia increase steadily with age. Recently, a disease severity model (the Pneumonia Prognosis Index (PPI)) has been developed to predict mortality from community-acquired pneumonia (CAP). PPI ranks severity of pneumonia from 1 to 5, with 5 being most severe. This retrospective study utilizes the PPI to address the prognosis of CAP in older adults.
  
  
  METHODS
  Retrospective review of medical charts.
  
  
  METHODS
  Department of Veterans Affairs Medical Center.
  
  
  METHODS
  All adults aged 60 and older admitted to a Veterans Affairs Medical Center with CAP between January 1 and December 31, 1998.
  
  
  METHODS
  PPI was calculated using subjects' demographics, comorbidities, presenting symptoms, and laboratory measurements.
  
  
  RESULTS
  Eighty-two patients aged 60 and older were admitted with 101 episodes of CAP. The mean age +/- standard deviation was 72 +/- 9. Seventy-four episodes were admitted from the emergency room, 20 from another hospital, seven from nursing homes, and five from outpatient clinics. Mean length of stay was 7.1 +/- 6 days. Comorbid conditions included coronary artery disease, diabetes mellitus, congestive heart failure, neoplasm, stroke, and renal failure. Most episodes fell into higher PPI classes, with 20% in Class 3, 46% in Class 4, and 32% in Class 5. PPI score was significantly related to length of stay (P < .001), intensity of care (P < .0001), and presence of complications (P <.001). Mortality was 14% at 30 days: 0.5% in Class 3,10.8% in Class 4, and 25% in Class 5.
  
  
  CONCLUSIONS
  The PPI was effective in identifying older adults with CAP who were at risk of a poor outcome, but the practical utility of this index remains to be determined.Further prospective studies are required to elucidate the importance of comorbidities, severity at presentation, and premorbid functional status on clinical and functional outcomes of CAP in older adults.
authors.affiliation: Division of Geriatric Medicine, University of Michigan Medical School, Ann Arbor, MI 48105, USA. lonamody@umich.edu
authors.forename: Lona
authors.initials: L
authors.lastname: Mody
authors.forename: Rongjun
authors.initials: R
authors.lastname: Sun
authors.forename: Suzanne
authors.initials: S
authors.lastname: Bradley
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017714:Community-Acquired Infections / Q000150:complications; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000150:complications*; D011379:Prognosis; D012189:Retrospective Studies; D014728:Veterans