Prognostic factors for community-acquired pneumonia in middle-aged and elderly patients treated with integrated medicine

Abstract Objective To identify prognostic factors in middle-aged and elderly patients with community-acquired pneumonia (CAP) who underwent integrated interventions involving traditional Chinese medicine (TCM) and modern medicine. Methods Patients aged ≥45 years and diagnosed with CAP were divided into a middle-aged cohort (45–59 years) and an elderly cohort (≥60 years), and clinical data comprising 75 predictor variables in seven classes were collected. After replacing missing data, calibrating multicenter differences and classifying quantitative data, univariate and multivariate analysis were performed. Results On multivariate analysis, eight independent risk factors – respiration rate, C reactive protein (CRP), cost of hospitalization, anemia, gasping, confusion, moist rales and pneumonia severity index (PSI) – were correlated with the outcome “not cured” in the elderly cohort. Nine factors – neutrophil percentage (Neu%), blood urea nitrogen (BUN), time to clinical stability, appetite, anemia, confusion, being retired or unemployed, Gram-negative bacterial infection and educational level – were correlated with not cured in the middle-aged cohort. Conclusion Independent predictive risk factors correlated with adverse outcomes in elderly patients were higher respiration rate, CRP≥four times the mean or median for the patient's center, cost of hospitalization> 11, 323 RMB and PSI>II, plus anemia, gasping, confusion and moist rales; those in middle-aged patients were higher Neu%, BUN≥ mean or median, loss of appetite, anemia, confusion, being retired or unemployed and lower educational level. Gram-negative bacterial infection and time to clinical stability>9 days were protective factors.