百岁老年住院患者临床特点及其转归的相关因素分析

Analysis of related factors for clinical characteristics and the outcome in centenarian hospitalized patients

目的了解南京地区百岁老年(≥100岁)住院患者的住院现况及其住院死亡的相关危险因素。方法从医院信息管理系统检索南京地区十家三级甲等医院住院病房出院的近5年年龄≥100岁的病例,采用回顾性分析方法分别登记患者一般资料、实验室检验资料,计算Charlson合并症指数(CCI)、中性粒细胞数/淋巴细胞数(NLR)和休克指数(SI)等,应用Logistic回归分析住院死亡的相关危险因素。结果收集过去5年≥100岁住院患者共156例,平均年龄(101.0±2.1)岁。入院第一诊断前3位疾病分别为肺部感染47例(30.1%)、冠心病17例(10.9%)、脑血管疾病11例(7.1%)。百岁老年住院患者中死亡50例(32.1%),其中第1位的入院诊断为肺部感染20例(40.0%);合并痴呆,合并慢性肾功能不全,合并1种、2种或多种基础病与百岁老年人住院患者死亡相关。死亡患者和好转患者在心率、SI、白细胞计数、中性粒细胞计数、NLR、血红蛋白、白蛋白、A/G、空腹血糖、血尿素氮、血肌酐、C反应蛋白和CCI水平的差异有统计学意义。多元Logistic回归分析提示NLR≥13.18、空腹血糖≥7.56 mmol/L、血尿素氮≥20.74mmol/L、C反应蛋白≥65 mg/L和CCI≥3可能是百岁老年人住院患者死亡预警指标(OR=48.91、3.43、1.22、6.55、1.55,均P<0.05)。结论肺部感染是百岁老年人最常见的入院原因和死亡原因,并发症增多增加百岁患者死亡风险;应利用CCI等评估指标,加强对百岁老年住院患者的综合评估和慢病管理,预防感染性疾病,降低住院死亡率。

Objective To investigate the health status of centenarian hospitalized patients and analyze the risk factors for in-hospital death in Nanjing district. Methods All centenarians hospitalized patients who were discharged from wards of 10 upper first-class general hospitals in Nanjing district during the past five years were retrieved from their hospital information systems.Then, a retrospective study was performed on centenarians' data of general information, laboratory test results, Charlson comorbidity index(CCI), neutrophil to lymphocyte ratio(NLR)and shock index(SI), etc.were calculated and collected.Relevant risk factors for in-hospital death were analyzed by multivariate logistic regression analysis. Results A total of 156 patients aged 100 years and over, with an average age of (101.0±2.1)years, were enrolled during the past 5 years.The top 3 admitting diagnosis for the patients were pulmonary infection(30.1%, 47/156 cases), coronary heart disease(10.9%, 17/156 cases)and cerebrovascular disease(7.1%, 11/156 cases). Fifty patients died during hospitalization, with a mortality of 32.1%(50/156). Pneumonia was the most common admitting diagnosis(40.0%, 20/50 case). Among causes of death, the combined admitting diagnosis with dementia, chronic renal insufficiency, one or more basic disease were significantly associated with death.There were statistically significant differences between bad vs.good vs.indifferent prognosis in heart rate, shock index, leukocyte count, neutrophil count, NLR, hemoglobin, albumin, albumin/globulin, fasting blood glucose, blood urea nitrogen, serum creatinine, C-reactive protein(CRP)and CCI levels.Multivariate logistic regression analysis suggested that NLR≥13.18, fasting blood glucose ≥7.56 mmol/L, blood urea nitrogen ≥20.74 mmol/L, CRP≥65 mg/L and CCI≥3 might be predictors for in-hospital death in the cohort(OR=48.91、3.43、1.22、6.55、1.55, all P<0.05). Conclusions Pulmonary infection is the most common reason for admission and the cause of death in centenarian inpatients.Comorbidities increase the risk of death.To lower in-hospital mortality, CCI and other assessment indicators should be used to strengthen the comprehensive assessment and chronic disease management of hospitalized centenarians.Infectious diseases should be prevented beforehand.