Community-acquired pneumonia in the elderly - A multivariate analysis of risk and prognostic factors
Community-acquired pneumonia in the elderly - A multivariate analysis of risk and prognostic factors
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DOI：
10.1164/ajrccm.154.5.8912763
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发表时间：
1996-11-01
影响因子：
24.7
通讯作者：
RodriguezRoisin, R
中科院分区：
文献类型：
--
作者：
Riquelme, R;Torres, A;RodriguezRoisin, R
为了评估需要住院治疗的老年人（65 岁以上）发生社区获得性肺炎的风险和预后因素，在一家拥有 1,000 个床位的大学教学医院进行了为期 8 个月的病例对照研究和队列研究。我们研究了 101 名肺炎患者（病例），年龄 78.5 +/- 7.9 岁（平均值 +/- SD）。每个病例的性别、年龄（+/- 5 岁）和入院日期（+/- 2 天）均与到达急诊室的前 3 年内没有肺炎的对照受试者相匹配。 101 例中有 43 例 (42%) 获得了病因诊断。引起肺炎的主要微生物为：肺炎链球菌（43 例中有 19 例，占 44%）和肺炎衣原体（43 例中有 9 例，占 21%）。 Cram 阴性杆菌并不常见（43 例中有 2 例，占 5%）。多变量分析表明，大量误吸和低血清白蛋白（< 30 mg/dl）是与肺炎发生相关的独立危险因素。粗死亡率为 26%（101 人中的 26 人），而肺炎相关死亡率为 20%（101 人中的 20 人）。归因死亡率为 23%（比值比 [OR]：11.3；95% 置信区间 [CI]：3.25 至 60.23；p < 0.0001）。多变量分析显示，如果患者既往卧床不起、既往有吞咽障碍、入院时体温低于37℃、呼吸频率大于30次/分钟或胸片显示有3个或更多肺叶受影响，则预后较差。年龄本身并不是与预后相关的重要因素。在重要的危险因素中，只有营养状况可能需要医疗干预。本研究中发现的预后因素可能有助于在入院时识别那些风险较高以及可能需要特殊观察的受试者。
To assess the risk and prognostic factors of community-acquired pneumonia occurring in the elderly (over age 65 yr) requiring hospitalization, two studies, case-control and cohort, were performed over an 8-mo period in a 1,000-bed university teaching hospital. We studied 101 patients with pneumonia (cases), age 78.5 +/- 7.9 yr (mean +/- SD). Each case was matched for sex, age (+/- 5 yr), and date of admission (+/- 2 d) with a control subject, without pneumonia during the preceding 3 yr, arriving at the emergency room. Etiologic diagnosis was obtained in 43 of 101 (42%) cases. The main microbial agents causing pneumonia were: Streptococcus pneumoniae (19 of 43, 44%), and Chlamydia pneumoniae (9 of 43, 21%). Cram-negative bacilli were uncommon (2 of 43, 5%). The multivariate analysis demonstrated that large-volume aspiration, and low serum albumin (< 30 mg/dl) were independent risk factors associated with the development of pneumonia. Crude mortality rate was 26% (26 of 101), while pneumonia-related mortality was 20% (20 of 101). The attributable mortality was 23% (odds ratio [OR]: 11.3; 95% confidence interval [CI]: 3.25 to 60.23; p < 0.0001). The multivariate analysis showed that patients had a worse prognosis if they were previously bedridden, had prior swallowing disorders, body temperature on admission was less than 37 degrees C, respiratory frequency was greater than 30/min or had three or more affected lobes on chest radiograph. Age by itself was not a significant factor related to prognosis. Among the significant risk factors, only nutritional status is probably amenable to medical intervention. The prognostic factors found in this study may help to identify, upon admission, those subjects at higher risk and who may require special observation.