Eur J Clin Microbiol Infect Dis (2001) 20 : 14–19 Q Springer-Verlag 2001 Article Clinical Aspects and Prognostic Factors in Elderly Patients Hospitalised for Community-Acquired Pneumonia M.A. García-Ordón ˜ ez, J.M. García-Jiménez, F. Páez, F. Álvarez, B. Poyato, M. Franquelo, J.D. Colmenero, C. Juárez Abstract The aims of this study were to determine the clinical and epidemiological characteristics of community-acquired pneumonia (CAP) in the elderly, to identify prognostic factors, and to establish a predictive model for mortality of CAP. Elderly patients with CAP admitted to “Carlos Haya” Hospital in Malaga, Spain, over a 36-month period were included. Multivariate analysis was used to identify prognostic factors from variables present on admission, from which a discrimination rule was constructed to predict mortality. A total of 343 patients were included, with the annual incidence ranging from 16.3 to 28.1 per 1,000 admissions. Most (82.5%) had some kind of accompanying or underlying disease. Clinical presentation was atypical in 87 (25.4%). Microbiological diagnosis was made in 24.5%. There were 49 (14.3%) deaths. The prognostic factors in multivariate analysis on admission were bilateral radiographic infiltrate, a blood urea nitrogen level of more than 7 mmol/l, absence of fever, a respiratory rate of 30/min or more, confusion, and shock. The discriminating rule to predict mortality comprising three or more of these factors was 91.2% specific, with a negative predictive value of 93.4% and an overall accuracy of 86.9%. CAP in the elderly is associated with a high degree of mortality. The discriminating rule incorporating the prognostic factors identified is a powerful predictor of mortality. M.A. García-Ordón ˜ ez, J.M. García-Jiménez, F. Páez, F. Álvarez, B. Poyato, M. Franquelo, J.D. Colmenero, C. Juárez Complejo Hospitalario Universitario “Carlos Haya”, Málaga, Spain M.A. García-Ordón ˜ ez (Y) c/ Horacio Lengo 17, 4 B, 29006 Málaga, Spain e-mail: magomalaga6airtel.net Tel.: c34-95-1061435 Fax: c34-95-1061435 Introduction Due to its high incidence and considerable morbidity and mortality, community-acquired pneumonia (CAP) in the elderly represents a very important public health problem [1]. Despite the availability of adequate anti- microbial agents, CAP is still one of the main causes of death in this age group, with mortality rates ranging from 16 to 33% [2–4]. Although age has been reported to be an independent risk factor for death in several studies analysing outcome in CAP [5–7], age by itself is not the only factor giving rise to the high incidence and mortality rates of CAP in the elderly. Other associated factors often present in the elderly could also be involved [8–9]. Knowledge of those factors determining a worse outcome in CAP may help in decisions concerning hospitalisation and the initial treatment of these patients. Although prior studies have described many factors associated with an increased risk of death in a nonselected population due to CAP [10], few have focussed on the prognostic factors in an exclusively elderly population. We therefore analysed the epidem- iological characteristics and the clinical spectrum of CAP in the elderly to identify those prognostic features influencing mortality. Patients and Methods Selection of Cases. We studied all patients aged 65 years or older who were admitted with CAP to a 1,000-bed teaching hospital from January 1996 to December 1998. CAP was defined as (i) the presence of a new pulmonary infiltrate suggestive of pneumonia