Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
BMC Geriatr. 2010 May 11;10:22. doi: 10.1186/1471-2318-10-22.
A better understanding of potentially modifiable predictors of in-hospital mortality and re-admission to the hospital following discharge may help to improve management of community-acquired pneumonia in older adults. We aimed to assess the associations of potentially modifiable factors with mortality and re-hospitalization in older adults hospitalized with community-acquired pneumonia.
A prospective cohort study was conducted from July 2003 to April 2005 in two Canadian cities. Patients aged 65 years or older hospitalized for community-acquired pneumonia were followed up for up to 30 days from initial hospitalization for mortality and these patients who were discharged alive within 30 days of initial hospitalization were followed up to 90 days of initial hospitalization for re-hospitalization. Separate logistic regression analyses were performed identify the predictors of mortality and re-hospitalization.
Of 717 enrolled patients hospitalized for community-acquired pneumonia, 49 (6.8%) died within 30 days of hospital admission. Among these patients, 526 were discharged alive within 30 days of hospitalization of whom 58 (11.2%) were re-hospitalized within 90 days of initial hospitalization. History of hip fracture (odds ratio (OR) = 4.00, 95% confidence interval (CI) = (1.46, 10.96), P = .007), chronic obstructive pulmonary disease (OR = 2.31, 95% CI = (1.18, 4.50), P = .014), cerebrovascular disease (OR = 2.11, 95% CI = (1.03, 4.31), P = .040) were associated with mortality. Male sex (OR = 2.35, 95% CI = (1.13, 4.85), P = .022) was associated with re-hospitalization while vitamin E supplementation was protective (OR = 0.37 (0.16, 0.90), P = .028). Lower socioeconomic status, prior influenza and pneumococcal vaccinations, appropriate antibiotic prescription upon admission, and lower nutrition risk were not significantly associated with mortality or re-hospitalization.
Chronic comorbidities appear to be the most important predictors of death and re-hospitalization in older adults hospitalized with community-acquired pneumonia while vitamin E supplementation was protective.
更好地了解潜在可改变的预测因素，包括住院期间的死亡率和出院后再次住院，可能有助于改善老年人社区获得性肺炎的管理。我们旨在评估潜在可改变因素与老年人社区获得性肺炎住院患者的死亡率和再入院之间的关系。
一项前瞻性队列研究于 2003 年 7 月至 2005 年 4 月在加拿大的两个城市进行。年龄在 65 岁及以上因社区获得性肺炎住院的患者在初始住院后最多 30 天内进行死亡率随访，这些在初始住院后 30 天内存活出院的患者在初始住院后 90 天内进行再住院随访。进行了单独的逻辑回归分析以确定死亡率和再住院的预测因素。
在因社区获得性肺炎住院的 717 名患者中，有 49 名（6.8%）在入院后 30 天内死亡。在这些患者中，有 526 名在住院后 30 天内存活出院，其中有 58 名（11.2%）在初始住院后 90 天内再次住院。髋部骨折史（比值比（OR）=4.00，95%置信区间（CI）=（1.46，10.96），P=0.007）、慢性阻塞性肺疾病（OR=2.31，95%CI=（1.18，4.50），P=0.014）、脑血管疾病（OR=2.11，95%CI=（1.03，4.31），P=0.040）与死亡率相关。男性（OR=2.35，95%CI=（1.13，4.85），P=0.022）与再住院相关，而维生素 E 补充剂具有保护作用（OR=0.37（0.16，0.90），P=0.028）。较低的社会经济地位、既往流感和肺炎球菌疫苗接种、入院时适当的抗生素处方以及较低的营养风险与死亡率或再住院率无显著相关性。
在因社区获得性肺炎住院的老年人中，慢性合并症似乎是死亡和再住院的最重要预测因素，而维生素 E 补充剂具有保护作用。
