PROGNOSTIC SYSTEMS AND NOVEL BIOMARKERS IN COMMUNITY-ACQUIRED PNEUMONIA IN ELDERLY PATIENTS: CURRENT EVIDENCE AND LIMITATIONS (LITERATURE REVIEW)

Resume. Background. Traditional prognostic scores for community-acquired pneumonia (CAP), such as CURB-65 and the Pneumonia Severity Index (PSI), were developed and validated predominantly in general adult populations and may inadequately capture the specific risk profile of elderly patients with multimorbidity. Objective. To summarize current evidence on the performance limitations of conventional prognostic scores and the potential role of novel biomarkers, including interleukin-6 (IL-6), angiopoietin-2, D-dimer, and procalcitonin, in predicting severe outcomes of CAP in elderly patients. Materials and Methods. Publications in the PubMed/MEDLINE and Google Scholar databases from 1987 to 2026 were analyzed using the keywords "CURB-65," "pneumonia severity index," "comorbidity index," "biomarkers," "interleukin-6," "angiopoietin-2," "procalcitonin," and "elderly pneumonia." Results. Several cohort studies indicate reduced discriminative performance of CURB-65 and PSI in the oldest patients and in those with substantial comorbidity, while the Charlson Comorbidity Index has demonstrated superior discrimination for in-hospital mortality (AUC 0.83 vs. 0.73–0.75). Elevated IL-6 and procalcitonin levels are associated with increased mortality risk in CAP, and angiopoietin-2, a marker of endothelial dysfunction, has shown prognostic value in sepsis and may be relevant to severe pneumonia, although CAP-specific evidence for angiopoietin-2 remains limited. Conclusion. Conventional severity scores have recognized limitations in elderly patients with multimorbidity, supporting the rationale for developing integrated prognostic models that combine comorbidity indices, clinical characteristics, and biomarkers of inflammation and endothelial dysfunction. Keywords: community-acquired pneumonia; prognostic score; comorbidity index; biomarkers; elderly.

Hali tarjima qilinmagan