JOPIC

The JoPIC is an independent-unbiased, peer-reviewed, and open-access journal of current national and international issues and reviews for original clinical and experimental research, interesting case reports, surgical techniques, differential diagnoses, editorial opinions, letters to the editor, and educational papers in pulmonology, thoracic surgery, occupational diseases, allergology, and intensive care medicine.

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Original Article
Evaluation of the clinical course of acute phase reactants and associated factors in geriatric patients followed up in icu due to community- and hospital-acquired pneumonia
Aims: Advancing age leads to numerous physiopathological changes, particularly in the respiratory system. Moreover, biomarkers and acute phase reactants are affected by age-related inflammation and cellular and humoral immunity changes. Our aim in this study was to evaluate the age-related course of acute phase reactants in CAP and HAP patients and to assess its relationship with independent intra-intensive unit (ICU) mortality.
Methods: Patients followed up in intensive unit (ICU) due to community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP) were evaluated retrospectively. Patients were divided into four groups in terms of age: (I) 18-64 years, (II) 65-75 years, (III) 76-90 years, and (IV) 91+ years. Acute phase reactants were measured at ICU admission and at the 72 hours after admission.
Results: A total of 549 patients comprising 389 CAP and 160 HAP patients were included in the study. Mean age was 73 (range, 22-99) years and 33% of the participants were female. Age and gender were similar between the two groups. On laboratory examination, neutrophil count (NE), C-reactive protein (CRP), procalcitonin (PCT), procalcitonin and CRP were significantly higher in the HAP group than in the CAP group. The rate of intra-ICU independent mortality was significantly higher in HAP patients than in CAP patients (24.4% vs 11.6, p<0.001). All laboratory parameters except for lymphocyte count (LY) on admission was similar between the groups.
Conclusion: The response of LY to advancing age was greater than the response of other inflammatory acute phase reactants. In patients with severe pneumonia, serial measurement of WBC, CRP, PCT, and NE may be useful in predicting short-term intra-ICU mortality.


1. Akl Y, Elkomy A, Ibrahim EK. Acute phase reactants in non-COVID-19 community-acquired pneumonia. Egypt J Bronchol. 2023;17:57. <a href="https://doi.org/10.1186/s43168-023-00234-1">doi:10.1186/s43168-023-00234-1</a>
2. Pletz MW, Blasi F, Chalmers JD, et al. International perspective on the new 2019 American Thoracic Society/Infectious Diseases Society of America community-acquired pneumonia guideline: a critical appraisal by a global expert panel. Chest. 2020;158(5):1912-1918. <a href="https://doi.org/10.1016/j.chest.2020.07.089">doi:10.1016/j.chest.2020.07.089</a>
3. Viasus D, Simonetti AF, Estupiñan-Bohórquez AF, Carratalà J. Effects of age and comorbidities on serum levels of inflammatory markers in community-acquired pneumonia. Eur J Clin Invest. 2021;51(6):e13480. <a href="https://doi.org/10.1111/eci.13480">doi:10.1111/eci.13480</a>
4. van Vugt SF, Broekhuizen BD, Lammens C, et al. Use of serum C reactive protein and procalcitonin concentrations in addition to symptoms and signs to predict pneumonia in patients presenting to primary care with acute cough: diagnostic study. BMJ. 2013;346:f2450. <a href="https://doi.org/10.1136/bmj.f2450">doi:10.1136/bmj.f2450</a>
5. Ruiz González A, Utrillo L, Bielsa S, Falguera M, Porcel JM. The diagnostic value of serum C-reactive protein for identifying pneumonia in hospitalized patients with acute respiratory symptoms. J Biomark. 2016;2016:2198745. <a href="https://doi.org/10.1155/2016/2198745">doi:10.1155/2016/2198745</a>
6. Ozkaya S, Omercikoglu S, Altunbas E, Akoglu H, Denizbasi A. Association of acute phase reactants with prognostic scores in community acquired pneumonia. J Pak Med Assoc. 2021;71(2(B)):614-618. <a href="https://doi.org/10.47391/JPMA.630">doi:10.47391/JPMA.630</a>
7. Point-of-care CRP testing in the diagnosis of pneumonia in adults. Drug Ther Bull. 2016;54(10):117-120. <a href="https://doi.org/10.1136/dtb.2016.10.0432">doi:10.1136/dtb.2016.10.0432</a>
8. Ticinesi A, Lauretani F, Nouvenne A, et al. C-reactive protein (CRP) measurement in geriatric patients hospitalized for acute infection. Eur J Intern Med. 2017;37:7-12. <a href="https://doi.org/10.1016/j.ejim.2016.08.026">doi:10.1016/j.ejim.2016.08.026</a>
9. Simonetti AF, Viasus D, Garcia-Vidal C, Carratalà J. Management of community-acquired pneumonia in older adults. Ther Adv Infect Dis. 2014;2(1):3-16. <a href="https://doi.org/10.1177/2049936113518041">doi:10.1177/2049936113518041</a>
10. Cillóniz C, Rodríguez-Hurtado D, Torres A. Characteristics and management of community-acquired pneumonia in the era of global aging. Med Sci (Basel). 2018;6(2):35. <a href="https://doi.org/10.3390/medsci6020035">doi:10.3390/medsci6020035</a>
11. Nouvenne A, Ticinesi A, Folesani G, et al. The association of serum procalcitonin and high-sensitivity C-reactive protein with pneumonia in elderly multimorbid patients with respiratory symptoms: retrospective cohort study. BMC Geriatr. 2016;16:16. <a href="https://doi.org/10.1186/s12877-016-0192-7">doi:10.1186/s12877-016-0192-7</a>
12. Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44(suppl 2):S27-S72. <a href="https://doi.org/10.1086/511159">doi:10.1086/511159</a>
13. Kalil AC, Metersky ML, Klompas M, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis. 2016;63(5):e61-e111. <a href="https://doi.org/10.1093/cid/ciw353">doi:10.1093/cid/ciw353.</a> Epub 2016 Jul 14. Erratum in: Clin Infect Dis. 2017;64(9):1298. <a href="https://doi.org/10.1093/cid/ciw799">doi:10.1093/cid/ciw799.</a> Erratum in: Clin Infect Dis. 2017;65(8):1435. <a href="https://doi.org/10.1093/cid/cix587">doi:10.1093/cid/cix587</a>
14. Ferreira Coimbra J, Tejada S, Campogiani L, Rello J. Levels of evidence supporting European and American community-acquired pneumonia guidelines. Eur J Clin Microbiol Infect Dis. 2020;39(6):1159-1167. <a href="https://doi.org/10.1007/s10096-020-03833-8">doi:10.1007/s10096-020-03833-8</a>
15. Varghese YE, Kalaiselvan MS, Renuka MK, Arunkumar AS. Comparison of Acute Physiology And Chronic Health Evaluation II (APACHE II) and Acute Physiology And Chronic Health Evaluation IV (APACHE IV) severity of illness scoring systems, in a multidisciplinary ICU. J Anaesthesiol Clin Pharmacol. 2017;33(2):248-253. <a href="https://doi.org/10.4103/0970-9185.209741">doi:10.4103/0970-9185.209741</a>
16. Fimognari FL, De Vincentis A, Arone A, Baffa Bellucci F, Ricchio R, Antonelli Incalzi R. Clinical outcomes and phenotypes of respiratory failure in older subjects admitted to an acute care geriatric hospital ward. Intern Emerg Med. 2024;19(5):1359-1367.<a href="https://doi.org/10.1007/s11739-024-03625-4">doi:10.1007/s11739-024-03625-4</a>
17. Lv C, Shi W, Pan T, et al. Exploration of aging-care parameters to predict mortality of patients aged 80-years and above with community-acquired pneumonia. Clin Interv Aging. 2022;17:1379-1391. <a href="https://doi.org/10.2147/CIA.S382347">doi:10.2147/CIA.S382347</a>
18. Cillóniz C, Dominedò C, Pericàs JM, Rodriguez-Hurtado D, Torres A. Community-acquired pneumonia in critically ill very old patients: a growing problem. Eur Respir Rev. 2020;29(155):190126. <a href="https://doi.org/10.1183/16000617.0126-2019">doi:10.1183/16000617.0126-2019</a>
19. Brunker LB, Boncyk CS, Rengel KF, Hughes CG. Elderly patients and management in intensive care units (ICU): clinical challenges. Clin Interv Aging. 2023;18:93-112. <a href="https://doi.org/10.2147/CIA.S365968">doi:10.2147/CIA.S365968</a>
20. Pan J, Bu W, Guo T, Geng Z, Shao M. Development and validation of an in-hospital mortality risk prediction model for patients with severe community-acquired pneumonia in the intensive care unit. BMC Pulm Med. 2023;23(1):303. <a href="https://doi.org/10.1186/s12890-023-02567-5">doi:10.1186/s12890-023-02567-5</a>
21. Pieralli F, Vannucchi V, De Marzi G, et al. Performance status and in-hospital mortality of elderly patients with community acquired pneumonia. Intern Emerg Med. 2018;13(4):501-507. <a href="https://doi.org/10.1007/s11739-018-1822-1">doi:10.1007/s11739-018-1822-1</a>
22. Kaplan V, Angus DC, Griffin MF, Clermont G, Watson RS, Linde-Zwirble WT. Hospitalized community-acquired pneumonia in the elderly: age- and sex-related patterns of care and outcome in the United States. Am J Respir Crit Care Med. 2002;165(6):766-772. <a href="https://doi.org/10.1164/ajrccm.165.6.2103038">doi:10.1164/ajrccm.165.6.2103038</a>
23. Cao B, Huang Y, She DY, et al. Diagnosis and treatment of community-acquired pneumonia in adults: 2016 clinical practice guidelines by the Chinese Thoracic Society, Chinese Medical Association. Clin Respir J. 2018;12(4):1320-1360. <a href="https://doi.org/10.1111/crj.12674">doi:10.1111/crj.12674</a>
24. Putot A, Tetu J, Perrin S, et al. Impact of microbiological samples in the hospital management of community-acquired, nursing home-acquired and hospital-acquired pneumonia in older patients. Eur J Clin Microbiol Infect Dis. 2016;35(3):489-495. <a href="https://doi.org/10.1007/s10096-015-2565-9">doi:10.1007/s10096-015-2565-9</a>
25. Perry HM 3rd. The endocrinology of aging. Clin Chem. 1999;45(8 pt 2):1369-1376.
26. Zhu Y, Zheng X, Huang K, et al. Mortality prediction using clinical and laboratory features in elderly patients with severe community-acquired pneumonia. Ann Palliat Med. 2021;10(10):10913-10921. <a href="https://doi.org/10.21037/apm-21-2537">doi:10.21037/apm-21-2537</a>
27. Nair GB, Niederman MS. Updates on community acquired pneumonia management in the ICU. Pharmacol Ther. 2021;217:107663. <a href="https://doi.org/10.1016/j.pharmthera.2020.107663">doi:10.1016/j.pharmthera.2020.107663</a>
28. Wei L, Xie H, Li J, et al. The prognostic value of geriatric nutritional risk index in elderly patients with severe community-acquired pneumonia: a retrospective study. Medicine (Baltimore). 2020;99(37):e22217. <a href="https://doi.org/10.1097/MD.0000000000022217">doi:10.1097/MD.0000000000022217</a>
29. Lv C, Pan T, Shi W, et al. Establishment of risk model for elderly CAP at different age stages: a single-center retrospective observational study. Sci Rep. 2023;13(1):12432. <a href="https://doi.org/10.1038/s41598-023-39542-3">doi:10.1038/s41598-023-39542-3</a>
30. Zan Y, Song W, Wang Y, et al. Nomogram for predicting in-hospital mortality of nonagenarians with community-acquired pneumonia. Geriatr Gerontol Int. 2022;22(8):635-641. <a href="https://doi.org/10.1111/ggi.14430">doi:10.1111/ggi.14430</a>
Volume 4, Issue 3, 2026
Page : 67-72
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