Novel score model predicts long-term prognosis in older adults with pneumonia

A new prediction score model identifies older patients with community-onset pneumonia who are nearing the end of life and need advance care planning (ACP) practices, reports a study.

This study included patients aged 65 years and above who were hospitalized for pneumonia at nine collaborating institutions. The researchers then prospectively obtained the prognosis of eligible patients 180 days following the completion of antimicrobial treatment for pneumonia.

A total of 399 older patients with community-acquired pneumonia (median age 82 years) were analysed, excluding seven outliers and 42 with missing data or unknown prognosis. They were randomized 8:2 for score development and testing. Of the participants, 68 died (17 percent).

In multivariate analysis, factors such as performance status (PS) ≥2 (odds ratio, 11.78), hypoalbuminaemia ≤2.5 g/dL (odds ratio, 5.28), and dementia (odds ratio, 3.15) were all significantly associated with prognosis, whereas age and detection of antimicrobial-resistant bacteria were not.

The researchers then developed a scoring model with PS ≥2, albumin ≤2.5, and dementia providing scores of 2, 1, and 1 each, respectively, for a total of 4. This model had an area under the curve of 0.8504, with a sensitivity of 94.6 percent and specificity of 61.7 percent at the cutoff value of 2.

In the test cases, the sensitivity of the new model was 91.7 percent, and the specificity was 63.1 percent at a cutoff value of 2.

“Patients meeting this score should be considered near the end of life, and the initiation of ACP practices should be considered,” the researchers said.