A New Prognosis Score to Predict Mortality After Acute Pneumonia in Very Elderly Patients.
Acute pneumonia (AP) induces an excess of mortality among the elderly. We evaluated the value of a new predictive biomarker index compared to usual prognosis scores for predicting in-hospital and 1-year mortalities in elderly inpatients with AP.



Retrospective study in 6 clinical departments of a university hospital.



Burgundy university hospital (France).



All patients aged 75 and over with AP and hospitalized between January 1 and June 30, 2013, in the departments of medicine (5) and intensive care (1) of our university hospital.



A new index, which we named UBMo, was created by multiplying the uremia (U in the formula) by the N-terminal-pro-brain natriuretic peptide (NT-proBNP) plasmatic rate (B), divided by the monocyte count (Mo).



Among the 217 patients included, there were 138 community-acquired pneumonia, 56 nursing home-acquired pneumonia, and 23 hospital-acquired pneumonia. In-hospital and 1-year mortality rates were respectively 19.8% and 43.8%. In multivariate analysis, Pneumonia Severity Index (PSI), unlike CURB-65 (confusion, urea >7 mmol/L, respiratory rate ≥30 breaths/min, blood pressure <90 mmHg systolic or ≤60 mmHg diastolic, age ≥65) score, was associated with in-hospital and 1-year mortalities. UBMo index performed better than PSI and CURB-65 scores in predicting both in-hospital and 1-year mortalities. For in-hospital mortality, the areas under the receiver operating characteristic curves (AUCs) were 0.89 (95% CI = 0.84-0.94), 0.72 (95% CI = 0.65-0.80), and 0.63 (95% CI = 0.54-0.72), respectively, for the 3 scores. For 1-year mortality, the AUCs were 0.93 (95% CI = 0.89-0.98), 0.66 (95% CI = 0.59-0.74), and 0.58 (95% CI = 0.50-0.66), respectively, for the 3 scores. The cut point for the UBMo index of 20,000 × 10-9ng·mmol/L had a sensitivity of 93.1% and 80.9% and a specificity of 76.3% and 95.8%, respectively, for in-hospital and 1-year mortalities.



If confirmed by prospective studies, the UBMo index appears very efficient in identifying patients at high risk of in-hospital and 1-year mortalities after an AP.
Department of Geriatrics and Internal Medicine, Hospital of Champmaillot, University Hospital, Dijon, France.
Alain
A
Putot
Department of Microbiology, University Hospital, Dijon, France.
Jennifer
J
Tetu
Department of Geriatrics and Internal Medicine, Hospital of Champmaillot, University Hospital, Dijon, France.
Sophie
S
Perrin
Department of Geriatrics and Internal Medicine, Hospital of Champmaillot, University Hospital, Dijon, France.
Henri
H
Bailly
Department of Infectious Diseases, University Hospital, Dijon, France.
Lionel
L
Piroth
Department of Internal Medicine and Systemic Diseases, University Hospital, Dijon, France.
Jean-François
JF
Besancenot
Department of Internal Medicine and Clinical Immunology, University Hospital, Dijon, France.
Bernard
B
Bonnotte
Department of Infectious Diseases, University Hospital, Dijon, France.
Pascal
P
Chavanet
Medical Intensive Care Unit, University Hospital, Dijon, France.
Pierre-Emmanuel
PE
Charles
Department of Geriatrics and Internal Medicine, Hospital of Champmaillot, University Hospital, Dijon, France.
Hélène
H
Sordet-Guépet
Department of Geriatrics and Internal Medicine, Hospital of Champmaillot, University Hospital, Dijon, France; UMR Inserm/U1093 Cognition, Action, Sensorimotor Plasticity, University of Burgundy, Dijon, France. Electronic address: patrick.manckoundia@chu-dijon.fr.
Patrick
P
Manckoundia
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D005260:Female; D005602:France; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D011014:Pneumonia / Q000401:mortality*; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies
D015415:Biomarkers
Elderly; mortality; pneumonia; prognosis; score