Division of Respiratory Medicine, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan.
Respirology. 2010 Feb;15(2):319-25. doi: 10.1111/j.1440-1843.2009.01685.x. Epub 2010 Jan 11.
Clinical variables and laboratory data were compared to elucidate the risk factors associated with the development of ARDS among elderly patients with community-acquired pneumonia (CAP). The predictors for ARDS appeared to differ from the determinants of severity of CAP. ARDS developed less frequently among patients aged>or=85 years.
The incidence of and risk factors for ARDS among elderly patients with community-acquired pneumonia (CAP) have not been well characterized.
The clinical details of 221 consecutive patients aged>or=65 years, who were admitted with CAP during the period April 2006 to June 2008, were investigated by review of patient charts. Clinical variables and laboratory data at admission for CAP were compared between patients with and without ARDS.
Eighteen patients (8.1%) developed ARDS 1-5 days after admission. The mortality rate was 44% in patients with ARDS and 10.3% in those without ARDS (P<0.001). The incidence of ARDS was 8.5-20% among patients aged<85 years and 1.1% in patients aged>or=85 years (P<0.001), while overall mortality rates were not significantly different among the age groups. Predictors for the development of ARDS included higher serum levels of CRP and glucose, lower PaO2/fraction of inspired O2 (FiO2), PaCO2 and HCO3-, and the presence of systemic inflammatory response syndrome at admission. ARDS developed less frequently among patients with pneumonia associated with oropharyngeal aspiration (AP). Multivariate analysis indicated that lower age, serum glucose, pre-existence of systemic inflammatory response syndrome and non-oropharyngeal AP were significant risk factors for ARDS. The Pneumonia Severity Index and confusion, urea, respiratory rate, blood pressure, age>or=65 score were not correlated with the incidence of ARDS.
Predictors for ARDS appeared to differ from the determinants of severity of CAP in the elderly. ARDS developed less frequently in patients aged>or=85 years and in those with oropharyngeal AP. It is important to identify subjects at high risk for ARDS upon admission and to observe them closely.
尚未很好地明确老年社区获得性肺炎（CAP）患者发生 ARDS 的发病率和危险因素。
通过查阅病历，对 2006 年 4 月至 2008 年 6 月期间因 CAP 住院的 221 例连续就诊的年龄>or=65 岁患者的临床资料进行了研究。比较了 CAP 患者发生 ARDS 与未发生 ARDS 者的临床变量和入院时实验室数据。
18 例（8.1%）患者在入院后 1-5 天发生 ARDS。ARDS 患者的死亡率为 44%，无 ARDS 患者为 10.3%（P<0.001）。年龄<85 岁者 ARDS 的发生率为 8.5-20%，年龄>or=85 岁者为 1.1%（P<0.001），但各年龄组间死亡率无显著差异。发生 ARDS 的预测因子包括 CRP 和血糖血清水平较高、PaO2/吸入氧分数（FiO2）较低、PaCO2 和 HCO3-较低以及入院时存在全身炎症反应综合征。与口咽吸入（AP）相关的肺炎患者中 ARDS 的发生率较低。多变量分析表明，年龄较小、血糖、入院时存在全身炎症反应综合征和非口咽 AP 是 ARDS 的显著危险因素。肺炎严重指数和意识障碍、尿素、呼吸频率、血压、年龄>or=65 岁评分与 ARDS 的发生率无关。
ARDS 的预测因子似乎与老年 CAP 的严重程度决定因素不同。年龄>or=85 岁者和口咽 AP 患者中 ARDS 的发生率较低。入院时识别发生 ARDS 的高危患者并密切观察非常重要。
