医院获得性肺炎老年患者预后的相关因素分析

Analysis of the prognostic factors for hospital-acquired pneumonia in elderly patients

目的 探讨影响医院获得性肺炎(HAP)老年患者预后的相关因素.方法 收集南京医科大学第一附属医院2015年10月至2020年10月收治的年龄≥60岁的HAP住院患者的资料,对其体质指数(BMI)、中性粒细胞计数/淋巴细胞计数(NLR)、查尔森合并症指数(CCI)、联合合并症评分(CCS)等指标进行回顾性分析,采用t检验、Logistic回归和受试者工作特征曲线(ROC)分析HAP老年患者预后的相关因素,并评价CCI评分、CCS评分对老年HAP患者预后的预测能力.结果 共收集完整病例200例,其中生存组158例、死亡组42例、死亡组与生存组患者的年龄、BMI、住院时间、意识状态、吞咽功能、是否留置胃管、是否使用质子泵抑制剂、白细胞计数、淋巴细胞计数、中性粒细胞计数、血红蛋白、NLR、白蛋白、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、D-二聚体、C反应蛋白、降钙素原的差异均有统计学意义(均P<0.05).死亡组CCI(6.79±2.86)分、CCS(6.21±3.08)分,显著高于生存组(3.42±1.98)分、(1.66±1.94)分(t=-7.193、-9.116,均 P<0.001).多因素 Logistic 回归分析结果显示,年龄>86 岁(OR=1.155、95%CI:1.014~1.316)、BMI<21.77 kg/m2(OR=0.651、95%CI:0.480~0.883)、中性粒细胞计数>10.10×109/L(OR=1.208、95%CI:1.025~1.422)、C 反应蛋白>59.32 mg/L(OR=1.055、95%CI:1.018~1.093)、CCS>6.21分(OR=2.859、95%CI:1.559~5.244)是老年HAP患者死亡的危险因素.CCI评分、CCS评分对老年HAP患者预后的预测能力进行ROC分析,结果提示,CCS评分对老年HAP患者死亡的预测能力优于 CCI 评分,ROC 曲线下面积分别为 0.831(95%CI:0.753~0.909)、0.898(95%CI:0.850~0.946)(均P<0.001).结论 老年HAP患者并发症多、病死率高,联合应用多个评估体系和临床指标可提高对老年HAP患者临床转归的预测能力.

Objective To explore the prognostic factors predicting the recovery of elderly patients with hospital-acquired pneumonia(HAP).Methods Data of HAP inpatients aged over 60 years in the First Affiliated Hospital of Nanjing Medical University between October 2015 and October 2020 were collected.Body mass index(BMI),neutrophil/lymphocyte rate(NLR),Charlson Comorbidity Index(CCI),Combined Comorbidity Score(CCS)and other data were retrospectively analyzed.The predictive value of the related factors was evaluated by using the Student's t test,the Logistic regression model and the receiver operating characteristic curve(ROC).Results A total of 200 cases were enrolled in this study,and grouped into survival group(n=158)and death group(n=42).There were significant differences between the death group and the survival group in length of age,BMI hospital stay,state of consciousness,swallowing function,indwelling gastric tube,the use of proton pump inhibitors,leukocyte count,lymphocyte count,neutrophil count,hemoglobin,NLR,albumin,alanine aminotransferase,aspartate aminotransferase,D-dimer,C-reaction protein,procalcitonin(all P<0.05).Scores of CCI and CCS were higher in the death group than in the survival group[(6.79±2.86)vs.(3.42±1.98),(6.21±3.08)vs.(1.66±1.94),t=-7.193,-9.116,both P<0.001].Multivariate Logistic analysis showed that age>86 years(OR=1.155,95%CI:1.014-1.316),BMI<21.77 kg/m2(OR=0.651,95%CI:0.480-0.883),neutrophil count>10.10×109/L(OR=1.208,95%CI:1.025-1.422),C-reaction protein>59.32 mg/L(OR=1.055,95%CI:1.018-1.093),CCS>6.21 scores(OR=2.859,95%CI:1.559-5.244)were risk factors for death inpatients aged 60 years and older with HAP.Area under the ROC curve showed that CCS could better predict the mortality of elderly patients than CCI,and the areas under the ROC curve were 0.831(95%CI:0.753-0.909)and 0.898(95%CI:0.850-0.946)respectively(both P<0.001).Conclusions The elderly patients with HAP are inclined to multiplecomplications and high mortality rates.Combined application of multiple assessment systems and clinical indicators can improve the ability to predict the outcome of HAP.