Importance of Functional Assessment in the Management of Community-acquired and Healthcare-associated Pneumonia
Importance of Functional Assessment in the Management of Community-acquired and Healthcare-associated Pneumonia
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DOI：
10.2169/internalmedicine.53.2499
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发表时间：
2014-01-01
影响因子：
1.2
通讯作者：
Kohno, Shigeru
中科院分区：
文献类型：
--
作者：
Kosai, Kosuke;Izumikawa, Koichi;Kohno, Shigeru
目的在日本，日常生活活动（ADL）有困难的老年人数量正在增加。本研究的目的是评估日常生活能力和肺炎的临床特征之间的关系。方法我们对219例因肺炎住院的成人患者进行了回顾性研究[151例社区获得性肺炎（CAP）和68例卫生保健相关性肺炎（HCAP）]。CAP、HCAP和所有患者使用改良版的Katz指数分为两组，即所有ADL独立或1 - 3个ADL依赖（CAP-A、HCAP-A和All-A组）和4个或5个ADL依赖（CAP-B、HCAP-B和All-B组）。比较两组患者的疾病严重程度、微生物学检查结果和死亡率。CAP严重程度测量指数（CAP严重程度测量指数）在CAP患者中显著增加，（CAP-A：1.1 +/- 1.1，CAP-B：2.6 +/- 1.1）、HCAP（HCAP-A：2.0 +/- 1.0，HCAP-B：2.8 +/- 1.0）和所有患者（所有-A：1.3 +/- 1.1，所有-B：2.8 +/- 1.0）。CAP-B组（23.1%）和All-B组（19.2%）的30天死亡率分别高于CAP-A组（0.7%）和All-A组（1.8%）。多变量考克斯比例风险分析显示，ADL评分≥ 4是CAP患者30天死亡率的重要预测因子[风险比（HR），19.057; 95%置信区间（CI），1.930-188.130]，结论采用改良Katz指数对CAP和HCAP患者进行功能评估是有效的。
Objective In Japan, the number of elderly people who have difficulties performing the activities of daily living (ADLs) is increasing. The objective of this study was to assess the relationship between ADL and the clinical characteristics of pneumonia.Methods We conducted a retrospective study of 219 adult patients hospitalized due to pneumonia [151 patients with community-acquired pneumonia (CAP) and 68 patients with healthcare-associated pneumonia (HCAP)]. CAP, HCAP, and all the patients were stratified into two groups using a modified version of the Katz index of five ADLs as follows: independent in all ADLs or dependent in one to three ADLs (CAP-A, HCAP-A, and All-A groups) and dependent in four or five ADLs (CAP-B, HCAP-B, and All-B groups). Disease severity, microbiological findings, and mortality were compared between the groups.Results As the ability to perform ADLs declined, A-DROP scores (the CAP severity measurement index) increased significantly in CAP (CAP-A: 1.1 +/- 1.1, CAP-B: 2.6 +/- 1.1), HCAP (HCAP-A: 2.0 +/- 1.0, HCAP-B: 2.8 +/- 1.0), and all patients (All-A: 1.3 +/- 1.1, All-B: 2.8 +/- 1.0). Thirty-day mortality was higher in the CAP-B (23.1%) and All-B (19.2%) groups than in the CAP-A (0.7%) and All-A (1.8%) groups, respectively. A multivariate Cox proportional hazards analysis showed an ADL score >= four to be a significant predictor of 30-day mortality in CAP patients [hazard ratio (HR), 19.057; 95% confidence interval (CI), 1.930-188.130] and in all patients (HR, 8.180; 95% CI, 1.998-33.494).Conclusion A functional assessment using a modified version of the Katz index is useful for the management of CAP and HCAP patients.