Department of Internal Medicine, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
Eur J Intern Med. 2012 Dec;23(8):720-6. doi: 10.1016/j.ejim.2012.08.006. Epub 2012 Sep 7.
Prognostic factors of mortality in elderly patients with dementia with aspiration pneumonia (AP) are scarcely known. We determined the mortality rate and prognostic factors in old patients with dementia hospitalized due to AP.
We prospectively studied 120 consecutive patients aged ≥ 75 years with dementia admitted with AP to two tertiary university hospitals. We collected data on demographic and clinical variables and comorbidities. Oropharyngeal swallowing was assessed by the water swallow test.
Sixty-one (50.8%) patients were female, and mean age was 86 ± 9 years. The swallow test was performed in 68 patients, revealing aspiration in 92.6%. Patients with repeat AP (28.3%) were more-frequently taking thickeners (61.8% vs.11.6%, p<0.0001) and were less-frequently prescribed angiotensin-converting-enzyme (ACE) inhibitors (8.8% vs. 27.9%, p<0.001) than patients with a first episode. Hospital mortality was 33.3%; these patients had lower lymphocyte counts and higher percentage of multilobar involvement. In the multivariate model, involvement of ≥ 2 pulmonary lobes was associated with hospital mortality (OR 3.051, 95% CI 1.248 to 7.458, p<0.01). Six-month mortality was 50.8%; these patients were older and had worse functional capacity and laboratory data indicative of malnutrition. In the multivariate model, lower albumin levels were associated with six-month mortality (OR 1.129, 95% CI 1.008 to 1.265, p<0.03).
In-hospital and 6-month mortality were high (one-third and one-half patients, respectively). Multilobar involvement and lower lymphocyte counts were associated with hospital mortality, and older age, greater dependence and malnutrition with six-month mortality.
老年痴呆伴吸入性肺炎（AP）患者的死亡率预后因素知之甚少。我们确定了因 AP 住院的老年痴呆症患者的死亡率和预后因素。
我们前瞻性研究了 120 例连续的年龄≥ 75 岁、因 AP 入住两家三级大学医院的痴呆症患者。我们收集了人口统计学和临床变量以及合并症的数据。通过饮水试验评估口咽吞咽情况。
61 例（50.8%）为女性，平均年龄为 86 ± 9 岁。68 例患者进行了吞咽测试，发现 92.6%有吸入。有复发性 AP（28.3%）的患者更常使用增稠剂（61.8%比 11.6%，p<0.0001），更少使用血管紧张素转换酶（ACE）抑制剂（8.8%比 27.9%，p<0.001）。住院死亡率为 33.3%；这些患者的淋巴细胞计数较低，多肺叶受累的比例较高。在多变量模型中，≥ 2 个肺叶受累与住院死亡率相关（OR 3.051，95%CI 1.248 至 7.458，p<0.01）。6 个月死亡率为 50.8%；这些患者年龄较大，功能能力和实验室数据更差，表明营养不良。在多变量模型中，白蛋白水平较低与 6 个月死亡率相关（OR 1.129，95%CI 1.008 至 1.265，p<0.03）。
住院和 6 个月死亡率均较高（分别为三分之一和一半患者）。多肺叶受累和较低的淋巴细胞计数与住院死亡率相关，而年龄较大、依赖性更大和营养不良与 6 个月死亡率相关。
