老年胆系感染患者临床特征分析及死亡风险评估

A retrospective analysis of clinical characteristics and mortality risks in elderly patients with acute cholecystitis and cholangitis

目的探讨老年胆系感染患者的临床特征和死亡高危因素。方法纳入2000—2018年解放军总医院第二医学中心确诊并治疗的574例老年胆系感染患者,按照年龄段分为3组,Ⅰ组(65~74岁),Ⅱ组(75~84岁),Ⅲ组(≥85岁)。总结老年急性胆系感染患者的临床特征,并对死亡风险因素进行分析。结果Ⅰ组191例,Ⅱ组167例,Ⅲ组216例,平均年龄87.6岁。主要病因为胆系结石438例(76.3%),主要临床表现为腹痛361例(62.9%)、寒战359例(62.5%)、发热343例(59.8%)、黄疸271例(47.2%)和休克151例(26.3%)。Ⅲ组腹痛、发热的比例明显低于Ⅰ组和Ⅱ组,Charlson合并症指数明显高于Ⅰ组和Ⅱ组,急性胆管炎患者比例明显高于Ⅰ组和Ⅱ组,而且病情更加严重,差异均有统计学意义(P<0.05);Ⅲ组患者接受介入治疗的比例明显高于Ⅰ组和Ⅱ组(P<0.05),接受外科治疗的比例低于Ⅰ组和Ⅱ组(P<0.05)。入组患者病死率为6.1%(35/574)。死亡风险因素分析显示,Charlson合并症指数(OR=19.5)、高龄(OR=11.1)、肿瘤(OR=9.6)、合并菌血症(OR=7.4)、严重程度分级(OR=4.2)是老年胆系感染患者死亡的危险因素,P均<0.05。结论在老年急性胆系感染患者中,共病状态可能是影响患者预后的主要因素之一,高龄患者病情更重、死亡风险更高,需要进一步提高临床认识和制定针对性治疗策略。

Objective To analyze the clinical characteristics and explore the risk predictors on mortality in elderly patients with acute cholecystitis and cholangitis. Methods We conducted a retrospective analysis of elderly patients hospitalized in the Second Medical Center of General Liberation Army Hospital for acute cholecystitis and cholangitis during 2000 to 2018. Clinical data and risk predictors on mortality were assessed. The patients were stratified into three groups based on age:Ⅰ(65-74 years old),Ⅱ(75-84 years old), and Ⅲ(≥85 years old). Logistic regression analysis was used to identify the predictors of mortality. Results A total of 574 patients were finally enrolled with the mean age 87.6 years including 191 in group Ⅰ, 167 in group Ⅱ, and 216 in group Ⅲ. The main cause of acute cholecystitis and cholangitis was gallstone (76.3%),and the main symptom was abdominal pain (62.9%),followed by chills(62.5%),fever(59.8%),jaundice (47.2%) and septic shock(26.3%). Cholecystitis was the most common diagnosis in groups Ⅰ and Ⅱ,whereas it was cholangitis in group Ⅲ. Percutaneous transhepatic biliary/gallbladder drainage (PTBD/PTGD) and endoscopic retrograde cholangiopancreatography (ERCP) were administrated more frequently in groups Ⅲ. A total of 35 patients (6.1%) died during follow-up. Senior in age (OR=11.1),the Charlson comorbidity index (OR=19.5),cancers (OR=9.6),blood stream infections (OR=7.4),severity of cholecystitis and cholangitis (OR=4.2) were risk factors associated with mortality. Conclusions Even in the elderly patients with acute cholecystitis and cholangitis,comorbidity is one of the main factors affecting clinical outcomes. Due to the poor performance, this group of population presents more severe disease and undergoes conservative treatment strategies.