Community-acquired pneumonia in the elderly - Clinical and nutritional aspects
Community-acquired pneumonia in the elderly - Clinical and nutritional aspects
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DOI：
10.1164/ajrccm.156.6.9702005
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发表时间：
1997-12-01
影响因子：
24.7
通讯作者：
Soler, N
中科院分区：
文献类型：
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作者：
Riquelme, R;Torres, A;Soler, N
老年人社区获得性肺炎（CAP）的临床表现与其他年龄组的CAP不同。意识模糊、功能性身体能力改变和潜在疾病的失代偿可能作为独特的表现出现。营养不良也是该人群中CAP的相关特征。我们进行了一项研究，以评估临床和营养方面的CAP需要住院的老年患者（65岁以上）。101例肺炎患者，在8个月期间连续入住1,000张病床的教学医院，进行了研究（年龄：78 ± 8岁，平均值± SD）。将肺炎患者的营养状况和精神状态与性别、年龄和住院日期相匹配的对照人群（n = 101）进行比较。主要症状为呼吸困难（n = 71）、咳嗽（n = 67）和发热（n = 64）。仅在32例患者中观察到这些症状与CAP相关。最常见的相关疾病为心脏病（n = 38）和慢性阻塞性肺疾病（COPD）（n = 30）。77例（76%）肺炎发作临床分类为典型肺炎，24例为非典型肺炎。分离的微生物类型与CAP的临床表现之间没有关联，除了胸膜炎性胸痛，其在经典微生物引起的肺炎发作中更常见（p = 0.02）。多变量分析证实了这一点（相对风险[RR] = 11; 95%置信区间[CI]：1.7至65; p = 0.0099）。肺炎组（n = 25）和对照组（n = 18）的慢性痴呆患病率相似（p = 0.22）。然而，肺炎队列中谵妄或急性意识模糊的发生率显著高于对照组（45次vs 29次; p = 0.019）。只有16例肺炎患者被认为营养良好，而对照组有47例（p = 0.001）。与对照组患者（n = 31; 31%）相比，肺炎患者（n = 65; 70%）的营养不良类型以夸希奥科尔样营养不良为主（p = 0.001）。观察到的死亡率为26%（n = 26）。胸膜炎性胸痛是CAP（典型肺炎与非典型肺炎）中唯一可以指导经验性治疗策略的临床症状。谵妄和营养不良是CAP的常见临床表现。
Community-acquired pneumonia (CAP) in the elderly has a different clinical presentation than CAP in other age groups. Confusion, alteration of functional physical capacity, and decompensation of underlying illnesses may appear as unique manifestations. Malnutrition is also an associated feature of CAP in this population. We undertook a study to assess the clinical and nutritional aspects of CAP requiring hospitalization in elderly patients (over 65 yr of age). One hundred and one patients with pneumonia, consecutively admitted to a 1,000-bed teaching hospital over an 8-mo period, were studied (age: 78 +/- 8 yr, mean +/- SD). Nutritional aspects and the mental status of patients with pneumonia were compared with those of a control population (n = 101) matched for gender, age, and date of hospitalization. The main symptoms were dyspnea (n = 71), cough (n = 67), and fever (n = 64). The association of these symptoms with CAP was observed in only 32 patients. The most common associated conditions were cardiac disease (n = 38) and chronic obstructive pulmonary disease (COPD) (n = 30). Seventy-seven (76%) episodes of pneumonia were clinically classified as typical and 24 as atypical. There was no association between the type of isolated microorganism and the clinical presentation of CAP, except for pleuritic chest pain, which was more common in pneumonia episodes caused by classical microorganisms (p = 0.02). This was confirmed by a multivariate analysis (relative risk [RR] = 11; 95% confidence interval [CI]: 1.7 to 65; p = 0.0099). The prevalence of chronic dementia was similar in the pneumonia cohort (n = 25) and control group (n = 18) (p = 0.22). However, delirium or acute confusion were significantly more frequent in the pneumonia cohort than in controls (45 versus 29 episodes; p = 0.019). Only 16 patients with pneumonia were considered to be well nourished, as compared with 47 control patients (p = 0.001). Kwashiorkor-like malnutrition was the predominant type of malnutrition (n = 65; 70%) in the pneumonia patients as compared with the control patients (n = 31; 31%) (p = 0.001). The observed mortality was 26% (n = 26). Pleuritic chest pain is the only clinical symptom that can guide an empiric therapeutic strategy in CAP (typical versus atypical pneumonia). Both delirium and malnutrition were very common clinical manifestations of CAP in our study population.