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        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">The etiology&#44; presentation&#44; and prognosis of community-acquired pneumonia &#40;CAP&#41; among nursing home residents are believed to differ from those of other groups&#46; However&#44; few Spanish studies have confirmed those assumptions or studied regional differences in CAP etiology&#46;</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p class="elsevierStyleSimplePara elsevierViewall">A prospective study which included all patients over 65 years of age admitted to our hospital with CAP was carried out over a period of 18 months &#40;2002-2003&#41;&#46; We examined clinical&#44; analytical&#44; and radiographic characteristics paying particular attention to functional status&#8212;using the Eastern Cooperative Oncology Group &#40;ECOG&#41; scale and Barthel and Karnofsky indices&#8212; and comorbidity&#46; Two blood cultures&#44; a <span class="elsevierStyleItalic">Legionella</span> antigen test in urine&#44; and serology for atypical bacteria were used for the etiologic diagnosis&#59; bacterial cultures of respiratory samples were also used in certain cases&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">Ninety-one patients&#44; 25 of whom were nursing home residents&#44; were enrolled&#46; The nursing home residents were older than the other patients &#40;mean &#91;SD&#93; age of 82 &#91;4&#93; compared with 73 &#91;5&#93;&#59; P&#61;&#46;0001&#41; and had greater comorbidity &#40;P&#61;&#46;0001&#41;&#8212;with a significantly greater presence of diabetes mellitus&#44; cerebrovascular disease&#44; congestive heart failure&#44; and dementia&#46; They also had a poorer functional status &#40;ECOG&#44; 2&#46;09 &#91;0&#46;9&#93; compared with 0&#46;93 &#91;1&#46;1&#93;&#44; <span class="elsevierStyleItalic">P</span> &#61; &#46;001&#59; Barthel Index&#44; 19 &#91;33&#93; compared with 77 &#91;35&#93;&#44; <span class="elsevierStyleItalic">P</span> &#61; &#46;001&#59; Karnofsky Index&#44; 51 &#91;17&#93; compared with 78 &#91;23&#93;&#44; <span class="elsevierStyleItalic">P</span> &#61; &#46;001&#41;&#46; Regarding clinical characteristics&#44; significant differences were found for respiratory rate &#40;39 &#91;11&#93; compared with 27 &#91;7&#93; breaths&#47;min&#59; P&#61;&#46;001&#41;&#44; blood pressure &#40;69&#46;5 &#91;20&#93; compared with 79&#46;2 &#91;18&#93; mm Hg&#59; P&#61;&#46;029&#41;&#44; and temperature &#40;36&#46;6 &#91;1&#46;2&#93; compared with 37&#46;7 &#91;1&#46;1&#93; &#176;C&#59; P&#61;&#46;001&#41;&#46; CAP patients from nursing homes presented a greater number of affected lobules in chest x-rays &#40;<span class="elsevierStyleItalic">P</span> &#61; &#46;004&#41;&#44; more hypoxemia&#44; acidosis&#44; anemia&#44; hypoalbuminemia&#44; and greater scores of urea and creatinine&#46; Fine Scale scores were also greater &#40;134 &#91;26&#93; compared with 95 &#91;28&#93;&#59; <span class="elsevierStyleItalic">P</span> &#61; &#46;001&#41; as was mortality &#40;7&#47;25 compared with 3&#47;66&#59; <span class="elsevierStyleItalic">P</span> &#61; &#46;005&#41;&#46; Few patients had an etiologic diagnosis and no significant differences were observed between the groups&#46; The variable that predicted mortality in elderly patients in this series&#44; according to stepwise logistic regression&#44; was urea &#40;adjusted R<span class="elsevierStyleSup">2</span>&#61;0&#46;452&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">In our sample population&#44; nursing home residents were older&#44; had greater comorbidity&#44; and severe functional impairment&#46; Under these circumstances the severity of CAP increases and becomes an important cause of mortality despite the fact that the etiologic agents do not appear to differ from those of the other patients&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">La neumon&#237;a adquirida en la comunidad &#40;NAC&#41; de los ancianos que viven en una residencia se considera dis-tinta del resto en cuanto a etiolog&#237;a&#44; forma de presentaci&#243;n y pron&#243;stico&#46; Sin embargo&#44; existen pocos estudios en nuestro pa&#237;s que confirmen estos aspectos&#44; sin olvidar las diferencias etiol&#243;gicas regionales de las NAC&#46;</p> <span class="elsevierStyleSectionTitle">Pacientes Y M&#233;todos</span><p class="elsevierStyleSimplePara elsevierViewall">Se ha realizado un estudio prospecti-vo de 18 meses de duraci&#243;n &#40;2002-2003&#41;&#44; en el que se ha inclui-do a todos los pacientes mayores de 65 a&#241;os que ingresaron por NAC en nuestro hospital&#46; Se recogieron las caracter&#237;sticas cl&#237;nicas&#44; anal&#237;ticas y radiol&#243;gicas haciendo especial hincapi&#233; en la situaci&#243;n funcional -escala del Eastern Cooperative Oncology Group &#40;ECOG&#41;&#44; &#237;ndices de Barthel y Karnofsky- y en la comorbilidad&#46; Para el diagn&#243;stico etiol&#243;gico se realizaron 2 hemocultivos&#44; ant&#237;geno de <span class="elsevierStyleItalic">Legionella</span> en orina y serolog&#237;a de g&#233;rmenes at&#237;picos&#59; en los casos indicados tambi&#233;n se practic&#243; cultivo bacteriol&#243;gico de muestras respiratorias&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">Se incluy&#243; a 91 pacientes&#44; de ellos 25 proced&#237;an de residencias&#46; Estos &#250;ltimos ten&#237;an mayor edad &#40;82 &#177; 4 frente a 73 &#177; 5 a&#241;os&#59; p &#61; 0&#44;0001&#41;&#44; mayor comorbilidad global &#40;p &#61; 0&#44;0001&#41; &#8212;como enfermedades aisladas eran significativamen-te m&#225;s comunes la diabetes mellitus&#44; la enfermedad cerebro-vascular&#44; la insuficiencia card&#237;aca congestiva cr&#243;nica y la de-mencia&#8212; y peor estado funcional &#40;ECOG&#58; 2&#44;09 &#177; 0&#44;9 frente a 0&#44;93 &#177; 1&#44;1&#44; p &#61; 0&#44;001&#59; &#237;ndice de Barthel&#58; 19 &#177; 33 frente a 77 &#177; 35&#44; p &#61; 0&#44;001&#59; &#237;ndice de Karnofsky&#58; 51 &#177; 17 frente a 78 &#177; 23&#44; p &#61; 0&#44;001&#41;&#46; En cuanto a las caracter&#237;sticas cl&#237;nicas&#44; encontramos diferencias significativas en la frecuencia respiratoria &#40;39 &#177; 11 frente a 27 &#177; 7 respiraciones&#47;min&#59; p &#61; 0&#44;001&#41;&#44; la presi&#243;n arterial diast&#243;lica &#40;69&#44;5 &#177; 20 frente a 79&#44;2 &#177; 18 mmHg&#59; p &#61; 0&#44;029&#41; y en la temperatura &#40;36&#44;6 &#177; 1&#44;2 frente a 37&#44;7 &#177; 1&#44;1 &#176;C&#59; p &#61; 0&#44;001&#41;&#46; En la radiograf&#237;a de t&#243;rax&#44; la NAC de residencia present&#243; mayor n&#250;mero de l&#243;bulos afectados &#40;p &#61; 0&#44;004&#41;&#46; Adem&#225;s&#44; estos pacientes ten&#237;an mayor hipoxemia&#44; acidosis&#44; anemia&#44; hipoalbuminemia y elevaci&#243;n de las cifras de urea y creatinina&#46; Asimismo&#44; la puntuaci&#243;n en la escala de Fine fue superior &#40;134 &#177; 26 frente a 95 &#177; 28&#59; p &#61; 0&#44;001&#41; y presentaron mayor mortalidad &#40;7&#47;25 frente a 3&#47;66&#59; p &#61; 0&#44;005&#41;&#46; En la ma-yor&#237;a de los pacientes no se pudo encontrar un diagn&#243;stico etiol&#243;gico&#44; pero no se observaron diferencias significativas entre ambos grupos&#46; La variable predictora de mortalidad de los ancianos de la serie &#8212;modelo de regresi&#243;n &#40;pasos su-cesivos&#41;&#8212; fue la urea &#40;R<span class="elsevierStyleSup">2</span> corregida &#61; 0&#44;452&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">En nuestra poblaci&#243;n&#44; los ancianos que viven en residencias tienen mayor edad&#44; pluripatolog&#237;a e importante deterioro funcional&#46; En estas circunstancias la NAC adquiere especial gravedad y es una causa importante de mortalidad&#44; pese a que los agentes etiol&#243;gicos no parecen diferir de los habituales&#46;</p>"
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Vol. 40. Issue 12.
Pages 547-552 (December 2004)
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Vol. 40. Issue 12.
Pages 547-552 (December 2004)
Original Articles
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Community-Acquired Pneumonia Among the Elderly: Differences Between Patients Living at Home and in Nursing Homes
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E. Martínez-Moragóna, L. García Ferrerb,
Corresponding author
emm01v@saludalia.com

Correspondence: Dra. E. Martínez- Moragón. Servicio de Neumología. Hospital de Sagunto. Avda. Ramón y Cajal, s/n. 46520 Port Sagunt. Valencia. España
, B. Serra Sanchosb, E. Fernández Fabrellasa, A. Gómez Beldab, R. Julve Pardob
a Servicio de Neumología, Hospital de Sagunto, Port Sagunt, Valencia, Spain
b Servicio de Medicina Interna, Hospital de Sagunto, Port Sagunt, Valencia, Spain
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Abstract
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Objective

The etiology, presentation, and prognosis of community-acquired pneumonia (CAP) among nursing home residents are believed to differ from those of other groups. However, few Spanish studies have confirmed those assumptions or studied regional differences in CAP etiology.

Patients and methods

A prospective study which included all patients over 65 years of age admitted to our hospital with CAP was carried out over a period of 18 months (2002-2003). We examined clinical, analytical, and radiographic characteristics paying particular attention to functional status—using the Eastern Cooperative Oncology Group (ECOG) scale and Barthel and Karnofsky indices— and comorbidity. Two blood cultures, a Legionella antigen test in urine, and serology for atypical bacteria were used for the etiologic diagnosis; bacterial cultures of respiratory samples were also used in certain cases.

Results

Ninety-one patients, 25 of whom were nursing home residents, were enrolled. The nursing home residents were older than the other patients (mean [SD] age of 82 [4] compared with 73 [5]; P=.0001) and had greater comorbidity (P=.0001)—with a significantly greater presence of diabetes mellitus, cerebrovascular disease, congestive heart failure, and dementia. They also had a poorer functional status (ECOG, 2.09 [0.9] compared with 0.93 [1.1], P = .001; Barthel Index, 19 [33] compared with 77 [35], P = .001; Karnofsky Index, 51 [17] compared with 78 [23], P = .001). Regarding clinical characteristics, significant differences were found for respiratory rate (39 [11] compared with 27 [7] breaths/min; P=.001), blood pressure (69.5 [20] compared with 79.2 [18] mm Hg; P=.029), and temperature (36.6 [1.2] compared with 37.7 [1.1] °C; P=.001). CAP patients from nursing homes presented a greater number of affected lobules in chest x-rays (P = .004), more hypoxemia, acidosis, anemia, hypoalbuminemia, and greater scores of urea and creatinine. Fine Scale scores were also greater (134 [26] compared with 95 [28]; P = .001) as was mortality (7/25 compared with 3/66; P = .005). Few patients had an etiologic diagnosis and no significant differences were observed between the groups. The variable that predicted mortality in elderly patients in this series, according to stepwise logistic regression, was urea (adjusted R2=0.452).

Conclusions

In our sample population, nursing home residents were older, had greater comorbidity, and severe functional impairment. Under these circumstances the severity of CAP increases and becomes an important cause of mortality despite the fact that the etiologic agents do not appear to differ from those of the other patients.

Key Words:
Community-acquired pneumonia
Elderly
Nursing home
Objetivo

La neumonía adquirida en la comunidad (NAC) de los ancianos que viven en una residencia se considera dis-tinta del resto en cuanto a etiología, forma de presentación y pronóstico. Sin embargo, existen pocos estudios en nuestro país que confirmen estos aspectos, sin olvidar las diferencias etiológicas regionales de las NAC.

Pacientes Y Métodos

Se ha realizado un estudio prospecti-vo de 18 meses de duración (2002-2003), en el que se ha inclui-do a todos los pacientes mayores de 65 años que ingresaron por NAC en nuestro hospital. Se recogieron las características clínicas, analíticas y radiológicas haciendo especial hincapié en la situación funcional -escala del Eastern Cooperative Oncology Group (ECOG), índices de Barthel y Karnofsky- y en la comorbilidad. Para el diagnóstico etiológico se realizaron 2 hemocultivos, antígeno de Legionella en orina y serología de gérmenes atípicos; en los casos indicados también se practicó cultivo bacteriológico de muestras respiratorias.

Resultados

Se incluyó a 91 pacientes, de ellos 25 procedían de residencias. Estos últimos tenían mayor edad (82 ± 4 frente a 73 ± 5 años; p = 0,0001), mayor comorbilidad global (p = 0,0001) —como enfermedades aisladas eran significativamen-te más comunes la diabetes mellitus, la enfermedad cerebro-vascular, la insuficiencia cardíaca congestiva crónica y la de-mencia— y peor estado funcional (ECOG: 2,09 ± 0,9 frente a 0,93 ± 1,1, p = 0,001; índice de Barthel: 19 ± 33 frente a 77 ± 35, p = 0,001; índice de Karnofsky: 51 ± 17 frente a 78 ± 23, p = 0,001). En cuanto a las características clínicas, encontramos diferencias significativas en la frecuencia respiratoria (39 ± 11 frente a 27 ± 7 respiraciones/min; p = 0,001), la presión arterial diastólica (69,5 ± 20 frente a 79,2 ± 18 mmHg; p = 0,029) y en la temperatura (36,6 ± 1,2 frente a 37,7 ± 1,1 °C; p = 0,001). En la radiografía de tórax, la NAC de residencia presentó mayor número de lóbulos afectados (p = 0,004). Además, estos pacientes tenían mayor hipoxemia, acidosis, anemia, hipoalbuminemia y elevación de las cifras de urea y creatinina. Asimismo, la puntuación en la escala de Fine fue superior (134 ± 26 frente a 95 ± 28; p = 0,001) y presentaron mayor mortalidad (7/25 frente a 3/66; p = 0,005). En la ma-yoría de los pacientes no se pudo encontrar un diagnóstico etiológico, pero no se observaron diferencias significativas entre ambos grupos. La variable predictora de mortalidad de los ancianos de la serie —modelo de regresión (pasos su-cesivos)— fue la urea (R2 corregida = 0,452).

Conclusiones

En nuestra población, los ancianos que viven en residencias tienen mayor edad, pluripatología e importante deterioro funcional. En estas circunstancias la NAC adquiere especial gravedad y es una causa importante de mortalidad, pese a que los agentes etiológicos no parecen diferir de los habituales.

Palabras clave:
Neumonía adquirida en la comunidad
Anciano
Residencia
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