Validation of the CORB75 (confusion, oxygen saturation, respiratory rate, blood pressure, and age ≥ 75 years) as a simpler pneumonia severity rule.

PURPOSE: This study compares the ability of two simpler severity rules (classical CRB65 vs. proposed CORB75) in predicting short-term mortality in elderly patients with community-acquired pneumonia (CAP). METHODS: A population-based study was undertaken involving 610 patients ≥ 65 years old with radiographically confirmed CAP diagnosed between 2008 and 2011 in Tarragona, Spain (350 cases in the derivation cohort, 260 cases in the validation cohort). Severity rules were calculated at the time of diagnosis, and 30-day mortality was considered as the dependent variable. The area under the receiver operating characteristic curves (AUC) was used to compare the discriminative power of the severity rules. RESULTS: Eighty deaths (46 in the derivation and 34 in the validation cohorts) were observed, which gives a mortality rate of 13.1 % (15.6 % for hospitalized and 3.3 % for outpatient cases). After multivariable analyses, besides CRB (confusion, respiration rate ≥ 30/min, systolic blood pressure <90 mmHg or diastolic ≤ 60 mmHg), peripheral oxygen saturation (≤ 90 %) and age ≥ 75 years appeared to be associated with increasing 30-day mortality in the derivation cohort. The model showed adequate calibration for the derivation and validation cohorts. A modified CORB75 scoring system (similar to the classical CRB65, but adding oxygen saturation and increasing the age to 75 years) was constructed. The AUC statistics for predicting mortality in the derivation and validation cohorts were 0.79 and 0.82, respectively. In the derivation cohort, a CORB75 score ≥ 2 showed 78.3 % sensitivity and 65.5 % specificity for mortality (in the validation cohort, these were 82.4 and 71.7 %, respectively). CONCLUSIONS: The proposed CORB75 scoring system has good discriminative power in predicting short-term mortality among elderly people with CAP, which supports its use for severity assessment of these patients in primary care.

Effects of annual influenza vaccination on winter mortality in elderly people with chronic pulmonary disease.

BACKGROUND: Although there is a general agreement for the recommendation of the influenza vaccine to persons with chronic obstructive pulmonary disease (COPD), the magnitude of clinical effectiveness and benefit from the annual vaccination is controversial. We assessed the effects of annual influenza vaccination on winter mortality in older adults with COPD. METHODS: This prospective cohort study included 1298 Spanish community-dwelling individuals aged 65 years or older with a diagnosis of COPD followed from 1 January 2002 to 30 April 2005. The primary outcome was all-cause death during influenza periods (January-April). Multivariable Cox proportional hazard models adjusted by age, sex and comorbidity were used to evaluate vaccine effectiveness. RESULTS: Influenza vaccination was associated with a non-statistically significant 16% reduction in winter mortality among vaccinated COPD patients [unadjusted hazard ratio (HR): 0.84; 95% confidence interval (CI): 0.60-1.17]. Multivariable analysis showed that there was an insignificant trend towards a reduced mortality in the vaccinated group considering overall influenza periods 2002-2005 (adjusted HR: 0.76; 95% CI: 0.52-1.06; p=0.098). We estimated that, in the total COPD population, one death was prevented for every 187 annual vaccinations (95% CI: 62 to infinity). CONCLUSIONS: Our data suggest benefit from the influenza vaccination and support an annual vaccination strategy for elderly COPD patients.

¿Tenemos en cuenta el nivel de riesgo de los pacientes para prescribir la vacuna antineumocócica? / Do family physicians consider the risk

INTRODUCCIÓN. Aunque la actual vacuna antineumocócica 23-valente (VAN-23s) está disponible desde los años ochenta, está resultando difícil alcanzar altas coberturas en las diferentes poblaciones diana. Este estudio tuvo como objetivo conocer el grado de implementación de la recomendación de la VAN-23s y evaluar las tasas de vacunación antineumocócica entre la población mayor de 65 años en función de la presencia de patologías o factores de riesgo para padecer neumonía. MÉTODOS. Estudio observacional transversal, en el que se analizaron 11.241 personas mayores de 65 años adscritas a 8 centros de Atención Primaria de Tarragona-Valls. Mediante revisión de historias clínicas informatizadas y del registro informático de vacunaciones, se valoró en cada paciente si había recibido la VAN-23s, así como la presencia de enfermedades o factores de riesgo para sufrir neumonía. RESULTADOS. La cobertura vacunal global fue 44,4% (intervalo de confianza [IC] 95%: 43,9-44,9). El 63,2% del total de vacunaciones antineumocócicas se había administrado durante los meses de octubre o noviembre. Las coberturas variaban significativamente con la edad (p < 0,001), partiendo desde una cobertura mínima en 65-70 años (28,9%), ascendiendo progresivamente hasta una cobertura máxima en las personas de 80-84 años (56,7%) y decreciendo posteriormente en las edades más avanzadas. Las coberturas más altas se observaron en pacientes con neoplasia activa (56,7%), nefropatía crónica (55,3%) o enfermedad pulmonar crónica (54,2%), y la más baja en fumadores (38,9%). CONCLUSIONES. A pesar de una cobertura global aceptable, existen amplias bolsas de pacientes con alto riesgo de sufrir neumonía que no han recibido la vacuna antineumocócica

INTRODUCTION. Although the current 23-valent polysaccharide pneumococcal vaccine (PPV) has been available since the 1980's, it is proving difficult to achieve high rates of coverage in the different target populations. This study aimed to know the degree of implementation of the PPV recommendation and evaluate the antipneumococcal vaccination among the population over 65 years based on the presence of diseases or risk factors to suffer pneumonia. METHODS. Cross-sectional, observational study that analyzed 11241 persons over 65 years assigned to 8 Primary Care Centers of Tarragona-Valls. Using the electronic database of the clinical patient's records and computer vaccination registries, it was evaluated in each patient if they had been administered the PPV and the presence of diseases or risk factors to suffer pneumonia. RESULTS. Overall pneumococcal vaccine coverage was 44.4% (95% IC: 43.9-44.9). A total of 63.2% of the antipneumococcal vaccinations had been administered during the months of October and November. Coverage varied significantly with age (p < 0.001), beginning from a minimum coverage at 65-70 years (28.9%), and progressively increasing until a maximum coverage in those of 80-84 years (56.7%) and then decreasing in the more advanced ages. The highest coverage was observed in patients with active malignancy (56.7%), chronic nephropathy (55.3%) or chronic pulmonary disease (54.2%) and the lowest in smokers (38.9%). CONCLUSIONS. In spite of an acceptable global coverage, there are large groups of patients with high risk of suffering pneumonia who are not administered the antipneumococcal vaccination