Objective:To investigate the prognostic factors of community-acquired pneumonia(CAP)in the elderly.Methods:Clinical and laboratory data of elderly patients(≥65 years old)hospitalized for CAP in the Department of Respiratory and Critical Care Medicine of Beijing Hospital from January to December 2019 were retrospectively analyzed.The patients were followed up after discharge.The patients were divided into a death group and a survival group according to their prognosis, and long-term mortality risk factors were analyzed by Cox regression.Results:A total of 118 elderly patients hospitalized for CAP with a male-to-female ratio of 1∶1 were included.The follow-up period was 20.7-39.0 months, with a median follow-up time of 29.8 months.The all-cause cumulative mortality rates at 1-2, 3, 6, 12, 24, and 36 months after discharge were 3.4%(4/118), 4.2%(5/118), 5.1%(6/118), 9.3%(11/118), 16.1%(19/118), and 21.6%(24/118), respectively.Pneumonia was the leading cause of death.Multifactorial Cox regression indicated that the Charlson comorbidity index score( HR=1.42, 95% CI: 1.11-1.83, P=0.006), the score of activities of daily living at discharge( HR=0.44, 95% CI: 0.23-0.84, P=0.013), body mass index( HR=0.83, 95% CI: 0.72-0.97, P=0.012), and the level of serum albumin( HR=0.84, 95% CI: 0.73-0.98, P=0.031)were independently associated with long-term mortality. Conclusions:The leading cause of long-term death for elderly CAP patients after discharge is pneumonia.High Charlson comorbidity index scores, lower BMI, low serum albumin levels and low scores of activities of daily living at discharge are independent risk factors for long-term mortality in these patients.Therefore, in order to reduce the occurrence of adverse prognosis and improve the quality of life, a multidimensional, comprehensive assessment and timely intervention should be performed during the acute phase of the disease.

Objective:To explore the clinical characteristics of patients with pulmonary sarcoidosis complicated by pulmonary cryptococcosis, thereby enhancing the understanding of this clinical scenario.Methods:We report a case of pulmonary sarcoidosis complicated by pulmonary cryptococcosis treated at Beijing Hospital.The patient was diagnosed with stage Ⅱ pulmonary sarcoidosis via CT-guided percutaneous fine needle aspiration lung biopsy.However, during treatment with oral prednisone, a chest CT scan revealed newly developed multiple nodules in the right lower lobe.By considering the patient's medical history, imaging results, cryptococcal antigen(CrAg)levels, and treatment response, a diagnosis of pulmonary sarcoidosis complicated by pulmonary cryptococcosis was established.Additionally, we systematically reviewed the literature on pulmonary sarcoidosis complicated by pulmonary cryptococcosis published before April 2024, focusing on epidemiological characteristics, clinical manifestations, diagnosis, treatment, and prognosis.Results:A total of seven articles were obtained, and nine cases were reviewed in conjunction with this case.Among these, 55.6%(5/9)of the patients were male, with an average age of 51 years, and one-third of the patients were categorized as elderly.The stages of pulmonary sarcoidosis identified were stage Ⅰ and stage Ⅱ.Eight patients(88.9%, 8/9)were receiving glucocorticoids or other immunosuppressants at the time of cryptococcosis diagnosis.In the cases that specified the diagnostic method for cryptococcosis, serum cryptococcal antigen(CrAg)was found to be positive, including in three elderly patients.One patient did not receive antifungal treatment due to the rapid deterioration of his condition.During a follow-up period of at least six months, all patients remained clinically stable, with fluconazole being the most chosen antifungal agent.Conclusions:Although cases of pulmonary sarcoidosis complicated by cryptococcal infection are rare, clinicians should remain vigilant to this possibility.The two conditions may exhibit overlapping clinical manifestations, yet their treatment strategies can be contradictory.Misdiagnosis and delayed diagnosis could result in serious clinical consequences.Serum CrAg testing is particularly useful for diagnosis, especially in elderly patients.