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Performance status and in-hospital mortality of elderly patients with community acquired pneumonia

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Abstract

To evaluate the role of performance status evaluated by the Eastern Cooperative Oncology Group (ECOG) score in predicting 30-day mortality in subjects hospitalized for community acquired pneumonia (CAP), this was a prospective study of patients consecutively hospitalized for CAP at a large University Hospital in Italy. Performance status was evaluated using the ECOG score that in a 0–5 point scale indicates progressive functional deterioration. The end-point of the study is the 30-day mortality. Two-hundred-sixteen patients were enrolled, 75.9% were aged > 70 years, 31.5% had severe pneumonia at CURB-65 score (3–4), and 27.5% of patients had severe disability (ECOG 3–4). Thirty-day mortality is 15.3%. Progression in ECOG score independently increases the probability of 30-day mortality at multivariable logistic regression analysis (HR 2.19, 95% CI 1.60–3.01, p < 0.0001). ECOG 3 or 4 determines a four-fold increase in 30-day mortality (HR 4.07, 95% CI 1.84–9.02, p < 0.001). ECOG score 3 or 4 is highly predictive of death in patients classified at low risk of mortality by CURB-65 (0–2 points) score. Functional status is directly related to outcome in elderly patients hospitalized for CAP. The use of a very simple and fast tool, such as the ECOG score, might help to better stratify the risk of short-term mortality, especially in patients otherwise classified at low risk of death by CURB-65 score.

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Authors and Affiliations

  1. Subintensiva di Medicina, Internal and Emergency Medicine Department, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy

    Filippo Pieralli, Giulia De Marzi, Antonio Mancini, Francesca Bacci, Ombretta Para & Carlo Nozzoli

  2. Internal Medicine, Santa Maria Nuova Hospital, USL Toscana Centro, Florence, Italy

    Vieri Vannucchi

  3. Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, Rome, Italy

    Marco Falcone

Authors
  1. Filippo Pieralli
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  2. Vieri Vannucchi
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  3. Giulia De Marzi
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  4. Antonio Mancini
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  5. Francesca Bacci
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  6. Ombretta Para
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  7. Carlo Nozzoli
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  8. Marco Falcone
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Contributions

All authors had access to the data and a role in writing the manuscript. Specifically, FP, VV, and MF wrote the first draft of the manuscript; FP and VV were responsible for the statistical analysis of data. All the other coauthors equally contributed to the final submission of the manuscript.

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Correspondence to Filippo Pieralli.

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Statement of human and animal rights

The study was conducted in compliance with the principles set in the Declaration of Helsinki.

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Informed consent was required for the participation to the study.

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Pieralli, F., Vannucchi, V., De Marzi, G. et al. Performance status and in-hospital mortality of elderly patients with community acquired pneumonia. Intern Emerg Med 13, 501–507 (2018). https://doi.org/10.1007/s11739-018-1822-1

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  • DOI: https://doi.org/10.1007/s11739-018-1822-1

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