谵妄与老年社区获得性肺炎患者住院期间死亡的相关分析

Correlative analysis of delirium and in-hospital death in elderly patients with communityacquired pneumonia

目的分析老年社区获得性肺炎患者谵妄的发生率及谵妄与老年社区获得性肺炎(CAP)患者住院期间死亡的关系。方法收集在本院接受治疗的老年CAP患者126例,分成死亡组(16例)和生存组(110例)。记录所有患者年龄、性别、体质量指数、并存疾病、谵妄发生、CURB-65评分、肺炎严重指数(PSI)评分、急性病生理学和长期健康评价(APACHE)Ⅱ评分等资料,采用单因素和多因素分析谵妄与住院期间死亡的关系,采用受试者工作特征曲线分析谵妄对住院期间死亡的预测价值。结果本组老年CAP患者发生谵妄29例(23.0%),谵妄患者住院期间病死率为31.0%(9/29),谵妄使老年CAP患者住院期间病死率增加5.785倍。单因素分析显示,与生存组相比,住院期间死亡组患者年龄更大、谵妄发生率更高、CURB-65评分、PSI评分及APACHEⅡ评分均显著升高(t=2.081,χ2=11.425,t=5.074、4.706、4.431,P均<0.05)。多因素Logistic回归分析显示,谵妄、CURB-65评分、PSI评分及APACHEⅡ评分是老年CAP患者住院期间死亡的独立危险因素(P均<0.05)。受试者工作特征曲线分析显示,谵妄预测住院期间死亡有中等曲线下面积及灵敏度和特异度,且与CURB-65评分、PSI评分及APACHEⅡ评分的曲线下面积比较,差异均无统计学意义(P均>0.05)。结论老年CAP患者谵妄发生率较高,谵妄是老年CAP患者住院期间死亡的独立危险因素,加强对谵妄的诊治可能降低CAP患者的病死率。

Objective To investigate the with community-acquired pneumonia （CAP）. delirium and in-hospital death in elderly patients Methods One-hundred and twenty-six elderly patients with CAP were divided into the death group （16 cases） and survival group （110 cases）. The characteristics of patients like age, gender, body weigh index, comorbidities, occurrence of delirium, CURB-65 score （confusion, urea, respiratory rate, blood pressure, and age ≥ 65 years）, pneumonia severity index score （PSI）, acute physiology and chronic health evaluation （APACHE） Ⅱ score and in-hospital death were recorded. The relationship between delirium and in-hospital death was analyzed using univariate and multivariate methods and the predictive value of delirium for in-hospital death was evaluated using receiver operating characteristic curve analysis. Results The elderly patients with community-acquired pneumonia, 29 cases （23.0%） had delirium. Inhospital mortality was 31.0% （9/29） in patients with delirium. And delirium increased 5.785 times in-hospital mortality in elderly patients with community-acquired pneumonia. Univariate analysis showed that patients in the death group had older age, higher incidence of delirium,higher CURB-65, PSI and APACHE Ⅱ scores than those in the survival group （t = 2.081, χ2= 11.425, t = 5.074, 4.706, 4.431, all P 〈 0.05）. Multivariate logistic regression analysis showed that delirium, CURB-65, PSI, APACHE II scores were all independent risk factors of in-hospital death in the elderly patients with CAP （all P 〈 0.05）. The delirium predicted in-hospital death with medium area under curve, sensitivity and specificity, but did not have significant differences as compared with those of CURB-65, PSI, APACHE Ⅱ scores by receiver operating characteristic curve analysis （all P〉 0.05）. Conclusion Delirium was an independent risk factor of in-hospital death in elderly patients with CAP, and improvement of the delirium diagnosis and treatment can reduce mortality in the patients with CAP.