年龄调整的Charlson共病指数对长寿老年人社区获得性肺炎院内死亡的影响以及预测评分模型

Impact of the age-adjusted Charlson comorbidity index on in-hospital mortality in long-living people with community-acquired pneumonia and a predictive mortality model

目的分析年龄调整的Charlson共病指数(aCCI)与年龄≥90岁的长寿老年人社区获得性肺炎(CAP)院内死亡风险的关联,并探索新的预测该人群院内死亡的评分模型。方法回顾性收集北京大学第三医院2010—2019年住院的长寿CAP患者性别、年龄、住院天数、住院费用、在院结局以及出入院诊断、合并疾病等基本信息及诊疗信息。采用多因素Logistic回归分析aCCI以及其他合并症与院内死亡的关联,使用受试者工作特征曲线(ROC)评估aCCI及新的评分模型预测长寿CAP患者院内死亡风险的价值。结果共纳入274例年龄≥90岁的长寿CAP患者,其中发生院内死亡病例85例。多因素Logistic回归分析结果显示,营养不良(OR=2.21,95%CI:1.05~4.67,P<0.05)、呼吸衰竭(OR=18.91,95%CI:9.34~38.25,P<0.001)、aCCI(OR=1.51,95%CI:1.23~1.85,P<0.001)是影响患者住院死亡的重要因素。基于上述结果,生成新的评分模型:营养不良、呼吸衰竭、aCCI组合(MRC)评分模型,aCCI评分单独预测长寿CAP患者院内死亡风险的ROC曲线下面积为0.743(95%CI:0.684~0.802),MRC评分预测长寿CAP患者院内死亡风险的ROC曲线下面积为0.891(95%CI:0.848~0.933),预测价值高于单独的aCCI评分(Z=6.337,P<0.001)。结论新的MRC评分模型可用于长寿CAP患者院内死亡风险的评估和预测。

ObjectiveTo investigate the relationship between the age-adjusted Charlson comorbidity index(aCCI)and the risk of in-hospital death for people aged≥90 years with community-acquired pneumonia(CAP),and to construct a novel scoring model for predicting in-hospital mortality.MethodsBasic personal and medical data about sex,age,hospitalization days,hospitalization expenses,in-hospital outcomes and discharge/admitting diagnosis of CAP patients aged≥90 years hospitalized in Peking University Third Hospital between 2010 and 2019 were collected retrospectively.Multivariate Logistic regression analysis was conducted to examine the association between aCCI or other complications and in-hospital death.The receiver operating characteristic curve(ROC)was used to assess the value of aCCI and a new scoring model in predicting in-hospital death of CAP in people aged≥90 years.ResultsA total of 274 CAP patients aged≥90 years were included in this study,of whom 85 died in hospital.Multivariate Logistic regression analysis showed that malnutrition(OR=2.21,95%CI:1.05-4.67,P<0.05),respiratory failure(OR=18.91,95%CI:9.34-38.25,P<0.001)and aCCI(OR=1.51,95%CI:1.23-1.85,P<0.001)were prognostic factors for in-hospital death in CAP patients aged≥90 years.Based on the above results,a novel scoring model,MRC(malnutrition,respiratory failure,aCCI)was established.The area under the ROC curve of the aCCI score for predicting the risk of in-hospital death in CAP patients aged≥90 years was 0.743(95%CI:0.684-0.802).The area under the ROC curve of the MRC score was 0.891(95%CI:0.848-0.933),indicating a higher predictive value than that of the aCCI score alone(Z=6.337,P<0.001).ConclusionsThe MRC score model can be used to evaluate and predict the risk of in-hospital death in long-living CAP patients.