血肌酐、PSI评分、血钙浓度与老年重症肺炎患者预后的相关性

Correlation Between Serum Creatinine,PSI Score,Blood Calcium Concentration and Prognosis of Elderly Patients with Severe Pneumonia

目的分析老年重症肺炎患者预后的影响因素及其与血肌酐、肺炎严重程度、血钙浓度的相关性。方法选取濮阳市人民医院2019年5月至2021年6月老年重症肺炎患者185例,根据入院28d预后情况分为两组,生存者103例纳入A组,死亡者82例纳入B组,收集性别(男/女)、年龄、治疗前检查患者肝功能指标[谷丙转氨酶(ALT)、谷草转氨酶(AST)]、白细胞计数(WBC)、肾功能指标[血肌酐(Scr)、血尿素氮(BUN)]、纤维蛋白原、血钙浓度,以肺炎严重指数(PSI)评分评估患者病情程度,以logistic回归行多因素分析。结果A组Scr水平低于B组,血钙浓度高于B组,PSI评分低于B组(P<0.05);Scr水平升高(OR=4.684,95%CI为2.461~8.914,P<0.001)、血钙浓度水平降低(OR=4.271,95%CI为1.662~10.975,P<0.001)、PSI评分提高(OR=4.919,95%CI为1.849~13.086,P<0.001)是老年重症肺炎患者疾病恶化的独立危险因素(P<0.05)。结论老年重症肺炎患者预后情况与Scr、血钙浓度、PSI评分关系密切,Scr高水平表达、血钙浓度水平降低、PSI评分较高预示患者存在较高恶化风险,对评估预后有一定参考价值,临床应积极采取干预措施预防疾病恶化,改善患者预后。

Objective To analyze the influencing factors of prognosis of elderly patients with severe pneumonia and the relationship between prognosis and the serum creatinine,severity of pneumonia,the blood calcium concentration.Methods A total of 185 elderly patients with severe pneumonia in Puyang People’s Hospital from May 2019 to June 2021 were selected and divided into two groups according to their disease progression 28 days after admission.One hundred and three existent were included in group A,and 82 deaths were included in group B.Gender(male/female),age,liver function indicators[alanine aminotransferase(ALT),aspartate aminotransferase(AST)],white blood cell count(WBC),renal function indexes[blood creatinine(Scr),blood urea nitrogen(BUN)],fibrinogen,blood calcium concentration were collected.The severity of pneumonia index(PSI)score was used to evaluate the patient’s condition,and the logistic regression was used multi-factor analysis.Results The Scr level of group A was lower than that of group B,the blood calcium concentration was higher than that of group B,ad the PSI score was lower than that of group B(P<0.05).Scr level was increased(OR=4.684,95%CI 2.461-8.914,P<0.001),blood calcium concentration level decreased(OR=4.271,95%CI 1.662-10.975,P<0.001),PSI score increased(OR=4.919,95%CI 1.849-13.086,P<0.001)were independent risk factors for elderly patients with severe pneumonia(P<0.05).Conclusion The prognosis of elderly patients with severe pneumonia is closely related to Scr,blood calcium concentration and PSI score.Higher level of Scr,lower blood calcium concentration,and higher PSI score indicate that the patient has a higher risk of deterioration,which has certain reference value to evaluating the disease prognosis,and clinical interventions should be actively taken to prevent disease deterioration and improve the prognosis of patients.