Background: The mortality of severe community acquired pneumonia (SCAP) is high in aged patients and do-not-resuscitate (DNR) decisions is a common issue during admission. In critically ill patients, a time-limited trial (TLT) of intensive care treatment can be helpful to identify who will benefit from life-sustaining interventions. In this study, we aim to identify factors associated with DNR decisions, 60-day mortality, and prognostic scores after TLT in aged adults hospitalized with SCAP in the intensive care unit (ICU).

Methods: Patients diagnosed with SCAP aged 65 and older were retrospectively enrolled in nine medical centers in Taiwan. DNR decisions and 60-day mortality were estimated with univariate and multivariate regression models. Cox regression analysis was used to assess factors associated with mortality.

Results: We enrolled 840 older adults, and 382 (45.5%) had a DNR directive. Among these patients, 18.9% experienced treatment failure, and 15.8% died within 60 days. The multivariate analysis identified six factors associated with mortality: CURB-65, comorbid heart failure, uremia, dementia, metastatic solid tumors, and failure of TLT within the first week. With these six factors, a novel clinical prognostic score was developed to predict mortality risk. 60-day mortality was significantly higher in those with prognostic score ?4 than < 4 (51.3% & 93.42%, p<0.001).

Conclusions: In patients with SCAP, a clinical prognostic score composite with TLT can assist physicians and relatives in deciding to DNR.