Conte H A, Chen Y T, Mehal W, Scinto J D, Quagliarello V J
Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut 06520, USA.
Am J Med. 1999 Jan;106(1):20-8. doi: 10.1016/s0002-9343(98)00369-6.
We sought to identify admission characteristics predicting mortality in elderly patients hospitalized with community-acquired pneumonia and to develop a prognostic staging system and discriminant rule.
We retrospectively analyzed data from 2,356 patients aged > or = 65 years admitted with community-acquired pneumonia. Multivariable analyses of a derivation cohort (n = 1,000) identified characteristics associated with hospital mortality. A staging system and discriminant rule based on these characteristics were tested in a validation cohort (n = 1,356). Our discriminant rule was compared with a rule formulated from a heterogeneous adult population with community-acquired pneumonia.
Hospital mortality rates were 9% (derivation cohort) and 12% (validation cohort). We identified five independent predictors of mortality: age > or = 85 years [odds ratio 1.8 (95% confidence interval 1.1-3.1)], comorbid disease [odds ratio 4.1 (2.1-8.1)], impaired motor response [odds ratio 2.3 (1.4-3.7)], vital sign abnormality [odds ratio 3.4 (2.1-5.4)], and creatinine level > or = 1.5 mg/dL [odds ratio 2.5 (1.5-4.2)]. These variables stratified patients into four distinct stages with increasing mortality in the derivation cohort (Stage 1, 2%; Stage 2, 7%; Stage 3, 22%; Stage 4, 45%; P = 0.001) as well as in the validation cohort (Stage 1, 4%; Stage 2, 11%; Stage 3, 23%; Stage 4, 41%; P = 0.001). The discriminant rule developed from the derivation cohort had greater overall accuracy (77.1%) in the validation cohort than a rule formulated from a heterogeneous adult population (68.0%, P = 0.001).
Elderly patients with community-acquired pneumonia have characteristics at admission that can predict mortality. Our staging system and discriminant rule improve prognostic stratification of these patients.
我们试图确定社区获得性肺炎住院老年患者的入院特征以预测死亡率，并开发一种预后分期系统和判别规则。
我们回顾性分析了2356例年龄≥65岁的社区获得性肺炎入院患者的数据。对一个推导队列（n = 1000）进行多变量分析，确定与医院死亡率相关的特征。基于这些特征的分期系统和判别规则在一个验证队列（n = 1356）中进行测试。我们的判别规则与从患有社区获得性肺炎的异质性成年人群中制定的规则进行比较。
医院死亡率在推导队列中为9%，在验证队列中为12%。我们确定了五个死亡率的独立预测因素：年龄≥85岁[比值比1.8（95%置信区间1.1 - 3.1）]、合并症[比值比4.1（2.1 - 8.1）]、运动反应受损[比值比2.3（1.4 - 3.7）]、生命体征异常[比值比3.4（2.1 - 5.4）]以及肌酐水平≥1.5mg/dL[比值比2.5（1.5 - 4.2）]。这些变量将患者分为四个不同阶段，在推导队列（1期，2%；2期，7%；3期，22%；4期，45%；P = 0.001）以及验证队列（1期，4%；2期，11%；3期，23%；4期，41%；P = 0.001）中死亡率逐渐增加。从推导队列开发的判别规则在验证队列中的总体准确性（77.1%）高于从异质性成年人群中制定的规则（68.0%，P = 0.001）。
社区获得性肺炎老年患者入院时具有可预测死亡率的特征。我们的分期系统和判别规则改善了这些患者的预后分层。
