老年人社区获得性肺炎远期预后的相关因素分析

The long-term mortality and related factors of community-acquired pneumonia in the elderly

目的探讨老年人社区获得性肺炎(CAP)远期预后的相关因素。方法回顾性分析北京医院呼吸与危重症医学科2019年1—12月因CAP住院的老年患者(≥65岁)临床资料和化验资料,在其出院后进行随访,根据临床结局将入组患者分为死亡组和存活组,采用Cox回归分析远期死亡(>1个月)的相关因素。结果共纳入118例因CAP住院的老年患者,男女比例为1∶1,随访时间为20.7~39.0个月,中位随访时间为29.8个月,出院后1~2个月、3个月、6个月、12个月、24个月、36个月全因累积死亡率分别为3.4%(4/118)、4.2%(5/118)、5.1%(6/118)、9.3%(11/118)、16.1%(19/118)、21.6%(24/118),肺炎为首要死亡原因。多因素Cox回归结果显示,患者Charlson共病指数(HR=1.42、95%CI:1.11~1.83、P=0.006),出院时日常生活能力评分(HR=0.44、95%CI:0.23~0.84、P=0.013),体质指数(HR=0.83、95%CI:0.72~0.97、P=0.012),白蛋白水平(HR=0.84,95%CI:0.73~0.98、P=0.031)与远期死亡结局独立相关。结论老年人CAP出院后远期死亡的首要原因为肺炎,高Charlson共病指数、低BMI及低白蛋白水平、出院时低日常生活能力评分是远期死亡的独立危险因素,在疾病急性期应多维度、综合评估并且及时干预,以期减少不良预后发生及提高生活质量。

Objective To investigate the prognostic factors of community-acquired pneumonia(CAP)in the elderly.Methods Clinical and laboratory data of elderly patients(≥65 years old)hospitalized for CAP in the Department of Respiratory and Critical Care Medicine of Beijing Hospital from January to December 2019 were retrospectively analyzed.The patients were followed up after discharge.The patients were divided into a death group and a survival group according to their prognosis,and long-term mortality risk factors were analyzed by Cox regression.Results A total of 118 elderly patients hospitalized for CAP with a male-to-female ratio of 1∶1 were included.The follow-up period was 20.7-39.0 months,with a median follow-up time of 29.8 months.The all-cause cumulative mortality rates at 1-2,3,6,12,24,and 36 months after discharge were 3.4%(4/118),4.2%(5/118),5.1%(6/118),9.3%(11/118),16.1%(19/118),and 21.6%(24/118),respectively.Pneumonia was the leading cause of death.Multifactorial Cox regression indicated that the Charlson comorbidity index score(HR=1.42,95%CI:1.11-1.83,P=0.006),the score of activities of daily living at discharge(HR=0.44,95%CI:0.23-0.84,P=0.013),body mass index(HR=0.83,95%CI:0.72-0.97,P=0.012),and the level of serum albumin(HR=0.84,95%CI:0.73-0.98,P=0.031)were independently associated with long-term mortality.Conclusions The leading cause of long-term death for elderly CAP patients after discharge is pneumonia.High Charlson comorbidity index scores,lower BMI,low serum albumin levels and low scores of activities of daily living at discharge are independent risk factors for long-term mortality in these patients.Therefore,in order to reduce the occurrence of adverse prognosis and improve the quality of life,a multidimensional,comprehensive assessment and timely intervention should be performed during the acute phase of the disease.