高龄老年人医院获得性肺炎合并脓毒症的高危因素及预后分析

Risk factors and prognosis of hospital-acquired pneumonia complicated with sepsis in very old patients

目的 分析高龄医院获得性肺炎(HAP)患者合并脓毒症的比例、危险因素及预后情况。方法 选取2017年1月至2020年12月于中国人民解放军中部战区总医院住院的156例高龄HAP患者,分为脓毒症组(72例)和非脓毒症组(84例),临床结局为住院期间病死率、28 d病死率及30 d再住院率。使用SPSS 22.0软件对数据进行分析。根据数据类型,组间比较分别采用t检验、Fisher检验及χ^(2)检验。危险因素采用logistic回归分析。结果 营养不良(OR=2.419,95%CI 1.151~5.084;P=0.020)、糖尿病(OR=2.335,95%CI 1.007~5.415;P=0.048)、慢性肾脏病(OR=7.602,95%CI 2.365~24.429;P=0.001)是脓毒症的独立危险因素。脓毒症组住院期间病死率、28 d病死率显著高于非脓毒症组[18例(25.0%)和8例(9.5%),21例(29.2%)和8例(9.5%),均P<0.05],2组患者的30 d再住院率无明显差异。营养不良(OR=3.331,95%CI 1.010~10.851;P=0.020)、慢性心力衰竭(OR=5.904,95%CI 1.947~17.903;P=0.048)、慢性肾脏病(OR=1.973,95%CI 1.243~13.619;P=0.001)为住院期间病死率的独立危险因素。结论 高龄HAP患者并发脓毒症可能与营养不良、糖尿病、慢性肾脏病相关,合并脓毒症后死亡率明显升高。

Objective To investigate the ratio,risk factors and prognosis of very old patients suffering from hospital-acquired pneumonia(HAP)complicated with sepsis.Methods A total of 156 very old HAP patients(≥80 years old)admitted in our hospital from January 2017 to December 2020 were recruited in this study.They were divided into sepsis group(n=72)and non-sepsis group(n=84).The clinical outcomes were observed,with the indicators such as in-hospital mortality,28-day mortality and 30-day readmission rates after discharge.SPSS 22.0 software was used for data analysis.Data comparison between two groups was perfomed using t test,Fisher test orχ^(2) test depending on data type.Logistic regression analysis was adopted to analyze the risk factors.Results Malnutrition(OR=2.419,95%CI 1.151-5.084,P=0.020),diabetes mellitus(OR=2.335,95%CI 1.007-5.415,P=0.048)and chronic renal disease(OR=7.602,95%CI 2.365-24.429,P=0.001)were independent risk factors for sepsis.There was no difference in 30-day readmission rate between the 2 groups,while the in-hospital and 28-day mortalities were significantly higher in the sepsis group than the non-sepsis group[18(25.0%)vs 8(9.5%),21(29.2%)vs 8(9.5%),both P<0.05].The independent risk factors of in-hospital mortality were malnutrition(OR=3.331,95%CI 1.010-10.851,P=0.020),chronic heart failure(OR=5.904,95%CI 1.947-17.903,P=0.048)and chronic renal disease(OR=1.973,95%CI 1.243-13.619,P=0.001).Conclusion Malnutrition,diabetes mellitus and chronic renal disease may be associated with the occurrence of sepsis in the very old HAP patients,and the complication greatly increases the mortality in the population.