La neumonía adquirida en la comunidad de los ancianos: diferencias entre los que viven en residencias y en domicilios particulares
Community-Acquired Pneumonia Among the Elderly: Differences Between Patients Living at Home and in Nursing Homes
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"apellidos" => "Martínez-Moragón" "email" => array:1 [ 0 => "emm01v@saludalia.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "L." "apellidos" => "García Ferrer" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "B." "apellidos" => "Serra Sanchis" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "E." "apellidos" => "Fernández Fabrellas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "A." "apellidos" => "Gómez Belda" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 5 => array:3 [ "nombre" => "R." "apellidos" => "Julve Pardo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Neumología. Hospital de Sagunto. Port Sagunt. Valencia" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Medicina Interna. Hospital de Sagunto. Port Sagunt. Valencia. España" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "*" "correspondencia" => "Correspondencia: Servicio de Neumología. Hospital de Sagunto.Avda. Ramón y Cajal, s/n. 46520. Port Sagunt. Valencia. España" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Community-Acquired Pneumonia Among the Elderly: Differences Between Patients Living at Home and in Nursing Homes" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2004-01-07" "fechaAceptado" => "2004-03-23" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec190021" "palabras" => array:3 [ 0 => "Neumonía adquirida en la comunidad" 1 => "Anciano" 2 => "Residencia" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec190022" "palabras" => array:3 [ 0 => "Community-acquired pneumonia" 1 => "Elderly" 2 => "Nursing home" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La neumonía adquirida en la comunidad (NAC) de los ancianos que viven en una residencia se considera distinta 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.</p> <span class="elsevierStyleSectionTitle">Pacientes Y Métodos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se ha realizado un estudio prospectivo de 18 meses de duración (2002–2003), en el que se ha incluido 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.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">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 significativamente más comunes la diabetes mellitus, la enfermedad cerebrovascular, la insuficiencia cardíaca congestiva crónica y la demencia— 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 mayoría 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 sucesivos)— fue la urea (R<span class="elsevierStyleSup">2</span> corregida = 0,452).</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">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.</p>" ] "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Patients And Methods</span><p id="spar0030" 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 (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.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">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]; <span class="elsevierStyleItalic">P</span> =.0001) and had greater comorbidity (<span class="elsevierStyleItalic">P</span>=.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], <span class="elsevierStyleItalic">P</span> =.001; Barthel Index, 19 [33] compared with 77 [35], <span class="elsevierStyleItalic">P</span> =.001; Karnofsky Index, 51 [17] compared with 78 [23], <span class="elsevierStyleItalic">P</span> =.001). Regarding clinical characteristics, significant differences were found for respiratory rate (39 [11] compared with 27 [7] breaths/min; <span class="elsevierStyleItalic">P</span> =.001), blood pressure (69.5 [20] compared with 79.2 [18] mm Hg; <span class="elsevierStyleItalic">P</span> =.029), and temperature (36.6 [1.2] compared with 37.7 [1.1] °C; <span class="elsevierStyleItalic">P</span> =.001). CAP patients from nursing homes presented a greater number of affected lobules in chest x-rays (<span class="elsevierStyleItalic">P</span>=.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]; <span class="elsevierStyleItalic">P</span> =.001) as was mortality (7/25 compared with 3/66; <span class="elsevierStyleItalic">P</span> =.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 R<span class="elsevierStyleSup">2</span>=0.452).</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">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.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:20 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of epidemic type A influenzae in a defined adult population" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "W.H. Barker" 1 => "J.P. Mullooly" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am J Epidem" "fecha" => "1980" "volumen" => "112" "paginaInicial" => "798" "paginaFinal" => "811" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2." 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 8 | 2 | 10 |
| 2024 October | 68 | 15 | 83 |
| 2024 September | 66 | 18 | 84 |
| 2024 August | 59 | 28 | 87 |
| 2024 July | 43 | 25 | 68 |
| 2024 June | 68 | 20 | 88 |
| 2024 May | 59 | 25 | 84 |
| 2024 April | 37 | 23 | 60 |
| 2024 March | 49 | 32 | 81 |
| 2024 February | 39 | 36 | 75 |
| 2024 January | 1 | 1 | 2 |
| 2023 December | 0 | 1 | 1 |
| 2023 November | 2 | 2 | 4 |
| 2023 October | 2 | 10 | 12 |
| 2023 September | 0 | 2 | 2 |
| 2023 July | 0 | 2 | 2 |
| 2023 April | 0 | 1 | 1 |
| 2023 March | 3 | 3 | 6 |
| 2023 February | 27 | 15 | 42 |
| 2023 January | 28 | 38 | 66 |
| 2022 December | 26 | 22 | 48 |
| 2022 November | 28 | 14 | 42 |
| 2022 October | 26 | 38 | 64 |
| 2022 September | 29 | 20 | 49 |
| 2022 August | 39 | 35 | 74 |
| 2022 July | 24 | 32 | 56 |
| 2022 June | 22 | 41 | 63 |
| 2022 May | 43 | 32 | 75 |
| 2022 April | 49 | 28 | 77 |
| 2022 March | 41 | 31 | 72 |
| 2022 February | 36 | 28 | 64 |
| 2022 January | 34 | 22 | 56 |
| 2021 December | 26 | 44 | 70 |
| 2021 November | 50 | 38 | 88 |
| 2021 October | 38 | 49 | 87 |
| 2021 September | 43 | 46 | 89 |
| 2021 August | 22 | 44 | 66 |
| 2021 July | 35 | 34 | 69 |
| 2021 June | 34 | 30 | 64 |
| 2021 May | 22 | 42 | 64 |
| 2021 April | 88 | 58 | 146 |
| 2021 March | 69 | 17 | 86 |
| 2021 February | 49 | 16 | 65 |
| 2021 January | 43 | 28 | 71 |
| 2020 December | 39 | 14 | 53 |
| 2020 November | 21 | 10 | 31 |
| 2020 October | 42 | 15 | 57 |
| 2020 September | 35 | 15 | 50 |
| 2020 August | 36 | 21 | 57 |
| 2020 July | 50 | 24 | 74 |
| 2020 June | 40 | 8 | 48 |
| 2020 May | 64 | 11 | 75 |
| 2020 April | 40 | 18 | 58 |
| 2020 March | 43 | 17 | 60 |
| 2020 February | 35 | 18 | 53 |
| 2020 January | 40 | 25 | 65 |
| 2019 December | 51 | 25 | 76 |
| 2019 November | 28 | 14 | 42 |
| 2019 October | 29 | 18 | 47 |
| 2019 September | 17 | 20 | 37 |
| 2019 August | 12 | 13 | 25 |
| 2019 July | 24 | 21 | 45 |
| 2019 June | 18 | 16 | 34 |
| 2019 May | 40 | 23 | 63 |
| 2019 April | 25 | 15 | 40 |
| 2019 March | 20 | 20 | 40 |
| 2019 February | 16 | 17 | 33 |
| 2019 January | 9 | 20 | 29 |
| 2018 December | 14 | 21 | 35 |
| 2018 November | 24 | 24 | 48 |
| 2018 October | 40 | 26 | 66 |
| 2018 September | 21 | 10 | 31 |
| 2018 May | 10 | 1 | 11 |
| 2018 April | 4 | 5 | 9 |
| 2018 March | 5 | 5 | 10 |
| 2018 February | 10 | 12 | 22 |
| 2018 January | 7 | 7 | 14 |
| 2017 December | 10 | 10 | 20 |
| 2017 November | 9 | 16 | 25 |
| 2017 October | 9 | 14 | 23 |
| 2017 September | 6 | 11 | 17 |
| 2017 August | 9 | 29 | 38 |
| 2017 July | 3 | 25 | 28 |
| 2017 June | 16 | 27 | 43 |
| 2017 May | 10 | 15 | 25 |
| 2017 April | 7 | 15 | 22 |
| 2017 March | 7 | 23 | 30 |
| 2017 February | 7 | 7 | 14 |
| 2017 January | 5 | 7 | 12 |
| 2016 December | 10 | 9 | 19 |
| 2016 November | 17 | 23 | 40 |
| 2016 October | 28 | 25 | 53 |
| 2016 September | 19 | 18 | 37 |
| 2016 August | 19 | 11 | 30 |
| 2016 July | 16 | 8 | 24 |
| 2016 June | 23 | 17 | 40 |
| 2016 May | 35 | 15 | 50 |
| 2016 April | 8 | 0 | 8 |
| 2016 March | 17 | 2 | 19 |
| 2016 February | 10 | 3 | 13 |
| 2016 January | 21 | 13 | 34 |
| 2015 December | 30 | 20 | 50 |
| 2015 November | 34 | 7 | 41 |
| 2015 October | 185 | 2 | 187 |
| 2015 September | 174 | 0 | 174 |
| 2015 August | 179 | 0 | 179 |
| 2015 July | 242 | 0 | 242 |
| 2015 June | 138 | 0 | 138 |
| 2015 May | 217 | 0 | 217 |
| 2015 April | 170 | 0 | 170 |
| 2015 March | 182 | 0 | 182 |
| 2015 February | 204 | 0 | 204 |
| 2015 January | 137 | 0 | 137 |
| 2014 December | 137 | 0 | 137 |
| 2014 November | 118 | 0 | 118 |
| 2014 October | 161 | 0 | 161 |
| 2014 September | 130 | 0 | 130 |
| 2014 August | 129 | 0 | 129 |
| 2014 July | 145 | 0 | 145 |
| 2014 June | 158 | 0 | 158 |
| 2014 May | 120 | 0 | 120 |
| 2014 April | 127 | 0 | 127 |
| 2014 March | 107 | 0 | 107 |
| 2014 February | 130 | 0 | 130 |
| 2014 January | 119 | 0 | 119 |
| 2013 December | 83 | 0 | 83 |
| 2013 November | 99 | 0 | 99 |
| 2013 October | 104 | 0 | 104 |
| 2013 September | 113 | 0 | 113 |
| 2013 August | 133 | 0 | 133 |
| 2013 July | 115 | 0 | 115 |
| 2013 June | 95 | 0 | 95 |
| 2013 May | 101 | 0 | 101 |
| 2013 April | 74 | 0 | 74 |
| 2013 March | 40 | 0 | 40 |
| 2000 January | 7045 | 0 | 7045 |
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