社区获得性肺炎老年重症患者的预后影响因素分析

Predictors of in-hospital outcome in elderly patients of severe community acquired pneumonia

目的:探索社区获得性肺炎老年重症患者的预后与72 h后CURB-65评分的关系。方法:收集从2010年1月至2014年3月的所有社区获得性肺炎老年重症患者的临床资料,并对数据进行提取与分析。结果:共136例患者纳入研究。老年重症肺炎患者好转组72 h后CURB-65评分低于未愈组,该评分与尿素、WBC呈正相关,与入院前病程呈负相关。影响老年重症肺炎患者预后的独立危险因素为使用头孢菌素类抗生素、谵妄及72 h后CURB-65评分,并且72 h后CURB-65评分降低者好转率高于评分不变者,该评分对于入院前病程在3 d以内患者的预后可能有指导意义。结论:抗生素、谵妄及72 h后CURB-65评分是影响社区获得性肺炎老年重症患者的预后因素。

Objective： To evaluate the predictors of in-hospital outcome in elderly patients hospitalized for severe community acquired pneumonia（ CAP）,such as CURB-65 score after 72 h. Methods： Clinical and laboratory characteristics were collected from electronic medical records between January 2010 and March 2014. Data were independently extracted by investigators and analyzed using SPSS. Results： 136 patients were enrolled. In elderly patients with severe pneumonia,we found after 72 h CURB-65 score was lower in patients improved（ cured） than those not convalesced（ dead）. 72 h CURB-65 score correlated with urea and leukocytosis,along with a negative correlation with disease course prior to admission. In patients who were improved,the use of cephalosporins was more frequent, while in those who were not convalesced,carbapenems were more likely to be chosen. At multivariate analysis,independent predictors of in-hospital outcome were： the use of cephalosporins in antibiotic therapy,the occurrence of delirium and CURB-65 score after 72 h. In addition,the improvement rate was higher in the group whose CURB-65 score decreased after 72 h treatment than those without change. 72 h CURB-65 score may play an important role of assessing the severity and mortality risk in those patients whose disease course prior to admission were within three days. Conclusion： Antibiotic therapy,delirium and CURB-65 score after 72 h represents a distinctive predictor of severe CAP in elderly patients,which merits further study.