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Pneumonie-Schwere-Index (PSI), CURB-65 und Mortalität bei hospitalisierten geriatrischen Patienten mit Aspirationspneumonie

Pneumonia Severity Index (PSI), CURB-65, and mortality in hospitalized elderly patients with aspiration pneumonia

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Zusammenfassung

Hintergrund

Die Aspirationspneumonie ist beim älteren Patienten mit einer hohen Morbidität und Mortalität assoziiert. Um eine adäquate medizinische Versorgung zu gewährleisten, ist die Etablierung verlässlicher prognostischer Marker notwendig.

Zielsetzung

Der Pneumonie-Schwere-Index (PSI) und der CURB-65-Score als valide Instrumente zur Prognoseabschätzung der ambulant erworbenen Pneumonie (CAP) werden daraufhin untersucht, ob damit auch die Prognose von hospitalisierten älteren Patienten mit Aspirationspneumonie vorhersagbar ist.

Material und Methoden

Die Daten von insgesamt 209 Patienten eines Zentrums, die zwischen 2001 und 2005 wegen Aspirationspneumonie stationär behandelt worden waren, wurden anhand des PSI und CURB-65-Scores ausgewertet. Zum Vergleich der Morbidität und Mortalität wurde eine gleich große Gruppe stationärer Patienten mit CAP herangezogen.

Ergebnisse

Der Altersdurchschnitt der Patienten mit Aspirationspneumonie betrug 76,7±13,4 Jahre, 104 (49,8%) Patienten waren weiblich. Im Vergleich zu Patienten mit CAP fanden sich bei denen mit Aspirationspneumonie signifikant häufiger eine positive Tumoranamnese sowie Hypotonie und Hyponatriämie. Die Mortalität lag im Vergleich zur CAP-Gruppe deutlich höher (39,2% vs. 16,3%). Bei der Aspirationspneumonie lag die Odds Ratio (OR) bezüglich Mortalität für einen CURB-65-Score von 3–5 Punkten im Vergleich zu 0–2 Punkten bei 1,03 (95%-Konfidenzintervall 0,59; 1,79). Bei Patienten mit CAP weist die OR für einen CURB-65-Score von 3–5 Punkten gegenüber 0–2 Punkten statistisch signifikante Risikoerhöhungen auf (OR 2,50; 95%-Konfidenzintervall 1,04; 6,06). Der PSI zeigt bei Aspirationspneumonie tendenziell eine Erhöhung der Mortalität mit steigender Risikoklasse an.

Schlussfolgerungen

Anders als bei der CAP sind weder der PSI noch der CURB-65-Score geeignet, die Prognose bei hospitalisierten geriatrischen Patienten mit Aspirationspneumonie vorherzusagen.

Abstract

Background

Aspiration pneumonia is associated with a high morbidity and mortality in elderly patients. In order to provide risk-adapted medical care, it is necessary to establish valid prognostic tools for these patients.

Objective

The value of two well-established scores to assess prognosis in community-acquired pneumonia (CAP), i.e., CURB-65 and the Pneumonia Severity Index (PSI), was evaluated in elderly patients hospitalized for aspiration pneumonia.

Material and methods

A total of 209 patients hospitalized with aspiration pneumonia between 2001 and 2005 in a single center were evaluated using PSI and CURB-65. For comparison of morbidity and mortality, an equally large group of inpatients with CAP was analyzed.

Results

The mean age of patients with aspiration pneumonia was 76.7±13.4 years, and 104 (49.8 %) were female. Patients with aspiration pneumonia more frequently showed a history of cancer, hypotension, and hyponatriemia on admission. Mortality was clearly higher in comparison to patients with CAP (39.2% vs. 16.3%). The Odds Ratio (OR) for mortality was 1.03 (95% CI 0.59; 1.79) for a CURB-65 score of 3–5 points compared to 0–2 points. In cases of CAP, OR showed a statistically significant increase of risk (OR 2.50; 95% CI 1.04; 6.06), for CURB-65 scores of 3–5 points vs. 0–2 points). In aspiration pneumonia, the PSI showed a trend towards increasing mortality within higher risk class.

Conclusions

In geriatric patients hospitalized with aspiration pneumonia, CURB-65 and PSI have no prognostic value.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: HJH erhält Vortragshonorare der Firmen Pfizer und MSD. HJH ist Stipendiat des Forschungskollegs Geriatrie der Robert-Bosch-Stiftung.

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Authors and Affiliations

  1. Klinik für Notfall- und internistische Intensivmedizin, Klinikum Nürnberg, Nürnberg, Deutschland

    H.J. Heppner

  2. Institut für Biomedizin des Alterns, Lehrstuhl Innere Medizin – Geriatrie, Universität Erlangen-Nürnberg, Nürnberg, Deutschland

    H.J. Heppner

  3. Klinik für Altersmedizin und Frührehabilitation, Marienhospital Herne, Klinikum der Ruhr-Universität Bochum, Widumer Str. 8, 44627, Herne, Deutschland

    B. Sehlhoff, D. Niklaus, L. Pientka &  U. Thiem

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  1. H.J. Heppner
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  2. B. Sehlhoff
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  3. D. Niklaus
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  4. L. Pientka
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  5. U. Thiem
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Correspondence to U. Thiem.

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Heppner, H., Sehlhoff, B., Niklaus, D. et al. Pneumonie-Schwere-Index (PSI), CURB-65 und Mortalität bei hospitalisierten geriatrischen Patienten mit Aspirationspneumonie. Z Gerontol Geriat 44, 229–234 (2011). https://doi.org/10.1007/s00391-011-0184-3

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