年龄仍然很重要：预测肺炎危重症患者的短期和长期死亡率。

Age still matters: prognosticating short- and long-term mortality for critically ill patients with pneumonia.

机构信息

Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.

出版信息

Crit Care Med. 2010 Nov;38(11):2126-32. doi: 10.1097/CCM.0b013e3181eedaeb.

DOI:10.1097/CCM.0b013e3181eedaeb

PMID:20818232

Abstract

OBJECTIVE

To determine the association between age and mortality in critically ill patients with pneumonia. We hypothesized that increasing age would be independently associated with both short- and long-term mortality.

DESIGN

Prospective population-based cohort study examining the association between age and 30-day (short-term) and 1-yr (long-term) mortality using Cox proportional hazards regression, adjusting for pneumonia severity, mechanical ventilation, sex, functional status, nursing home residence, and having a living will.

SETTING

Five intensive care units in Edmonton, Alberta, Canada.

PATIENTS

Critically ill adult patients with pneumonia.

MEASUREMENTS AND MAIN RESULTS

The cohort included 351 intensive care unit patients; mean age 61 yrs, 59% male, 16% from nursing homes. Mean Pneumonia Severity Index was 115 (73% Pneumonia Severity Index class IV or V), mean Acute Physiology and Chronic Health Evaluation II score 17, and 83% received invasive mechanical ventilation. Overall, 151 (43%) were < 60 yrs old, 64 (18%) were 60-69 yrs old, 82 (23%) were 70-79 yrs old, and 54 (15%) were ≥ 80 yrs old. By 30 days, 58 of 351 (17%) had died; by 1 yr, 112 of 351 (32%) had died. Mortality increased with age, 28 of 151 (19%) in those < 60 yrs, 14 of 64 (22%) in those 60-69 yrs, 39 of 82 (48%) in those 70-79 yrs, and 31 of 54 (57%) in those ≥ 80 yrs. Independent of pneumonia severity and other factors, age (per 10-yr increase) was associated with 30-day mortality (adjusted hazard ratio 1.24, 95% confidence interval 1.03-1.49, p = .026) and 1-yr mortality (adjusted hazard ratio 1.39, 95% confidence interval 1.21-1.60, p < .001). Having a living will was similarly associated with increased mortality (adjusted hazard ratio 3.08, 95% confidence interval 1.61-5.90, p < .001 at 30 days; adjusted hazard ratio 2.00, 95% confidence interval 1.21-3.32, p = .007 at 1 yr).

CONCLUSIONS

Increasing age was independently associated with risk-adjusted short- and long-term mortality in critically ill patients with pneumonia. These findings may help elderly patients, their families, and physicians better understand what intensive care unit admission can offer and help them to make more informed decisions.

摘要

目的

确定肺炎危重症患者的年龄与死亡率之间的关系。我们假设年龄的增加与短期和长期死亡率均独立相关。

设计

前瞻性基于人群的队列研究，使用 Cox 比例风险回归分析年龄与 30 天（短期）和 1 年（长期）死亡率之间的关系，调整肺炎严重程度、机械通气、性别、功能状态、疗养院居住情况和生前预嘱。

地点

加拿大阿尔伯塔省埃德蒙顿的 5 个重症监护病房。

患者

患有肺炎的重症成年患者。

测量和主要结果

该队列包括 351 例重症监护病房患者；平均年龄 61 岁，59%为男性，16%来自疗养院。平均肺炎严重指数为 115（73%为肺炎严重指数 IV 或 V 级），平均急性生理学和慢性健康评估 II 评分 17，83%接受了有创机械通气。总体而言，151 例（43%）年龄<60 岁，64 例（18%）年龄 60-69 岁，82 例（23%）年龄 70-79 岁，54 例（15%）年龄≥80 岁。在 30 天内，351 例患者中有 58 例（17%）死亡；1 年后，351 例患者中有 112 例（32%）死亡。死亡率随年龄增加而增加，年龄<60 岁的患者中为 28 例（19%），年龄 60-69 岁的患者中为 14 例（22%），年龄 70-79 岁的患者中为 39 例（48%），年龄≥80 岁的患者中为 31 例（57%）。独立于肺炎严重程度和其他因素，年龄（每增加 10 岁）与 30 天死亡率（校正后的危险比 1.24，95%置信区间 1.03-1.49，p =.026）和 1 年死亡率（校正后的危险比 1.39，95%置信区间 1.21-1.60，p<.001）相关。生前预嘱同样与死亡率增加相关（校正后的危险比 3.08，95%置信区间 1.61-5.90，p<.001 在 30 天；校正后的危险比 2.00，95%置信区间 1.21-3.32，p =.007 在 1 年）。