Cabré Mateu, Serra-Prat Mateu, Force Lluís, Palomera Elisabet, Pallarés Roman
Unidad Geriátrica de Agudos, Servicio de Medicina Interna, Hospital de Mataró, Mataró, Barcelona, España.
Med Clin (Barc). 2008 Jul 5;131(5):167-70. doi: 10.1157/13124262.
The most commonly used prognostic mortality indexes for pneumonia take into account several variables including comorbidities, physical examination results, and laboratory test results, as well as age. Other factors such as functional status are not included. The objective of this study was to know whether the preadmission functional status was related to 30-day mortality in old or very old patients who were hospitalized for pneumonia.
This was a prospective study including all patients who were hospitalized for pneumonia in the Acute Geriatric Unit of Hospital de Mataró, Barcelona. We calculated the Pneumonia Severity Index (PSI), preadmission and admission Barthel Index (BI), Charlson Comorbidity Index and Mini Nutritional Assessment (MNA). Patients were assessed during hospitalisation and until death or 30 days after admission.
We studied 117 patients, 69 (59%) were men. The mean age (standard deviation) was 84.7 (6.5) years. The 30-day mortality was 16.2%. The PSI score was 134.2 (31.8) on admission, and the BI scores on preadmission and admission were 60.3 (35.8) and 37.1 (33.5), respectively. In a multiple logistic regression model, using all variables statistically significant in the univariate analysis, those independently associated with 30-day mortality were: preadmission BI lower than 60 points (odds ratio = 4.89; 95% confidence interval, 1.27-18.9) and lymphopenia (odds ratio = 7.11; 95% confidence interval, 1.7-30.2).
In very old patients who were hospitalized for pneumonia, preadmission functional status was an independent predictor of mortality. Functional status should be included in the severity indices of pneumonia in this population.
肺炎最常用的预后死亡指数考虑了几个变量，包括合并症、体格检查结果、实验室检查结果以及年龄。其他因素如功能状态未被纳入。本研究的目的是了解入院前功能状态是否与因肺炎住院的老年或高龄患者的30天死亡率相关。
这是一项前瞻性研究，纳入了巴塞罗那马塔罗医院急性老年病科所有因肺炎住院的患者。我们计算了肺炎严重程度指数（PSI）、入院前和入院时的巴氏指数（BI）、查尔森合并症指数和微型营养评定（MNA）。在患者住院期间直至死亡或入院后30天进行评估。
我们研究了117例患者，其中69例（59%）为男性。平均年龄（标准差）为84.7（6.5）岁。30天死亡率为16.2%。入院时PSI评分为134.2（31.8），入院前和入院时的BI评分分别为60.3（35.8）和37.1（33.5）。在多因素逻辑回归模型中，使用单因素分析中所有具有统计学意义的变量，与30天死亡率独立相关的因素为：入院前BI低于60分（比值比=4.89；95%置信区间，1.27 - 18.9）和淋巴细胞减少（比值比=7.11；95%置信区间，1.7 - 30.2）。
在因肺炎住院的高龄患者中，入院前功能状态是死亡率的独立预测因素。该人群肺炎严重程度指数应纳入功能状态。
