老年重症肺炎患者凝血指标变化和抗凝治疗与预后的相关性

Correlation of changes in coagulation indices with anticoagulation therapy and the prognosis in elderly patients with severe pneumonia

目的探讨老年重症肺炎患者凝血指标变化及在D-二聚体、Padua评分指导下进行抗凝治疗对预后的意义。方法本研究为横断面研究。采用非随机抽样法,选取2022年12月至2023年9月在南京医科大学康达学院附属连云港第二人民医院确诊为重症肺炎的老年患者210例作为研究对象。将D-二聚体水平升高和(或)Padua评分>2分的患者纳入抗凝组(133例),依据抗凝效果,血栓风险未完全控制为抗凝1组(47例),血栓风险控制为抗凝2组(86例);Padua评分≤2分且D-二聚体水平正常者作为对照组(77例)。比较3组治疗前后凝血指标的变化及住院期间、出院后3个月的预后。采用逐步向前二元logistic回归分析老年重症肺炎患者死亡的危险因素。结果抗凝1组男33例,女14例,年龄(79.13±10.81)岁;抗凝2组男53例,女33例,年龄(78.59±7.81)岁;对照组男53例,女24例,年龄(79.73±9.11)岁。抗凝1组、抗凝2组Padua评分、总胆固醇、低密度脂蛋白胆固醇、无创呼吸机通气比率高于对照组(均P<0.05);抗凝2组Padua评分、无创呼吸机通气比率低于抗凝1组(均P<0.05);抗凝2组治疗后D-二聚体水平低于抗凝1组(P<0.05);抗凝1组、抗凝2组住院期间血栓发生率低于对照组(均P<0.05)。住院期间,抗凝1组、抗凝2组死亡率均低于对照组,抗凝2组死亡率低于抗凝1组(均P<0.05);出院后3个月内,抗凝2组死亡率低于对照组和抗凝1组(均P<0.05)。二元logistic回归分析结果显示休克、Padua评分增高、未抗凝、未充分抗凝是老年重症肺炎患者3个月内死亡的危险因素(均P<0.05)。结论老年重症肺炎患者依据D-二聚体和Padua评分进行充分抗凝治疗能降低住院期间及出院后3个月内死亡率。

ObjectiveTo investigate the prognostic significance of changes in coagulation indices and anticoagulation therapy guided by D-dimer and Padua score in elderly patients with severe pneumonia.MethodsThis was a cross-sectional study.A total of 210 elderly patients with severe pneumonia admitted in the Second People′s Hospital of Lianyungang Affiliated to Kangda College of Nanjing Medical University from December 2022 to September 2023 were selected by non-random sampling.The elderly patients with elevated D-dimer levels and/or Padua score>2 were included in the anticoagulation group(n=133).According to the anticoagulation effect,those with incomplete control of thrombotic risk were in the anticoagulation group 1(n=47),and those with control of thrombotic risk were in the anticoagulation group 2(n=86).The elderly patients with the normal D-dimer level and Padua score≤2 were in the control group(n=77).Changes in blood coagulation indexes of the three groups before and after treatment and 3 months after discharge were compared.Binary logistic regression was adopted to analyze the risk factors for mortality in elderly patients with severe pneumonia.ResultsIn the anticoagulation group 1,there were 33 males and 14 females with a mean age of 79.13±10.81 years.In the anticoagulation group 2,there were 53 males and 33 females with a mean age of 78.59±7.81 years.In the control group,there were 53 males and 24 females with a mean age of 79.73±9.11 years.Padua score,total cholesterol,low density lipoprotein cholesterol and ratio of non-invasive ventilator-assisted ventilation of the elderly patients in the anticoagulation group 1 and group 2 were significantly higher than those in the control group(all P<0.05).Padua score and ratio of non-invasive ventilator-assisted ventilation of the elderly patients in the anticoagulation group 2 were significantly lower than those in the group 1(all P<0.05).The post-treatment D-dimer level of the elderly patients in the anticoagulation group 2 was significantly lower than that in the group 1(P<0.05).The incidence of thrombosis during hospitalization in the anticoagulation group 1 and group 2 was significantly lower than that in the control group(all P<0.05).The mortality rate in the hospitalization of the elderly patients in the anticoagulation group 1 and group 2 was significantly significantly lower than that in the control group,which in the anticoagulation group 2 was significantly lower than that in the group 1(all P<0.05).The 3-month mortality of the elderly patients in the anticoagulation group 2 was significantly lower than that in the control group and the group 1(all P<0.05).Binary logistic regression analysis showed that no anticoagulation therapy,insufficient anticoagulation,Padua score,and shock were risk factors for 3-month mortality of severe pneumonia(all P<0.05).ConclusionAdequate anticoagulation based on D-dimer and Padua scores in elderly patients with severe pneumonia reduces the in-hospital mortality and 3-month mortality.