心血管事件对老年重症社区获得性肺炎30d病死率的影响

Effects of cardiovascular events on 30-day mortality of elderly patients with severe community-acquired pneumonia

目的探讨心血管事件(CVE)对老年重症社区获得性肺炎(CAP)患者30 d病死率的影响。方法将2012年1月至2014年6月期间符合老年重症CAP诊断标准并入院接受治疗的167例患者纳入研究,按照CAP指南进行规范化治疗。记录患者住院期间CVE发生情况及30 d病死率,采用Kaplan-Meier生存曲线分析合并CVE患者与未合并CVE患者的病死率情况,并采用Logistic多因素回归分析CVE对CAP患者30 d病死率的影响。结果 167例符合标准的重症CAP患者中,30 d病死率为28.7%(48/167),86例发生CVE(51.5%),合并CVE的CAP患者30 d病死率为39.5%(34/86),未合并CVE的CAP患者病死率为17.3%(14/81),两者比较差异有明显统计学意义(Log-rank检验,χ2=10.065,P=0.002)。Logistic多因素回归分析表明,并发CVE是老年重症CAP患者30 d死亡的独立危险因素(OR=1.997,P<0.05)。结论合并CVE的老年重症CAP患者有更高的30 d死亡风险。

Objective To evaluate the effect of cardiovascular events（CVE） on 30-day mortality of elderly patients with severe community-acquired pneumonia（CAP）. Methods Totally167 elderly severe CAP patients fulfilled this study inclusion criteria from January 2012 to June2014 in Shanghai Jiaotong University Affiliated Sixth People＇s Hospital were enrolled. The patients were treated following CAP standard guide. CVE complications and 30-day mortality were recorded.Kaplan-Meier survival curve and multivariate logistic regression analysis were used to assess the effect of CVE on 30-day mortality. Results In total of 167 elderly patients, 86（51.5%）patients developed CVE. The 30-day mortality was 28.7%（48 / 167）. The 30-day mortality in the elderly severe CAP patients with CVE complications was higher than the patients without CVE complications [39.5%（34 / 86） vs. 17.3%（14 / 81）, Log-rank test, χ2= 10.065, P = 0.002]. Multivariate logistic regression analysis showed that CVE complications was the independent risk factor of30-day mortality for elderly CAP patients（OR = 1.997, P〈0.05）. Conclusion CVE complications are common in elderly severe CAP patients, who are at a high risk of 30-day mortality.