Pieralli Filippo, Vannucchi Vieri, Mancini Antonio, Grazzini Maddalena, Paolacci Giulia, Morettini Alessandro, Nozzoli Carlo
Internal and Emergency Medicine Unit, General and University Hospital of Careggi, Florence, Italy.
Intern Emerg Med. 2014 Mar;9(2):195-200. doi: 10.1007/s11739-013-0991-1. Epub 2013 Sep 19.
Community acquired pneumonia (CAP) is a common reason for hospitalization and death in elderly people. Many predictors of in-hospital outcome have been studied in the general population with CAP. However, data are lacking on the prognostic significance of conditions unique to older patients, such as delirium and the coexistence of multiple comorbidities. The aim of this study was to evaluate predictors of in-hospital outcome in elderly patients hospitalized for CAP. In this retrospective study, consecutive patients with CAP aged ≥65 years were enrolled between January 2011 and June 2012 in two general wards. Clinical and laboratory characteristics were collected from electronic medical records. The end-point of the study was the occurrence of in-hospital death. 443 patients (mean age 81.8 ± 7.5, range 65-99 years) were enrolled. More than 3 comorbidities were present in 31 % of patients. Mean confusion, blood urea nitrogen, respiratory rate, blood pressure and age ≥65 years (CURB-65) score was 2.5 ± 0.7 points. Mean length of stay was 7.6 ± 5.7 days. In-hospital death occurred in 54 patients (12.2 %). At multivariate analysis, independent predictors of in-hospital death were: chronic obstructive pulmonary disease (COPD) (OR 6.21, p = 0.005), occurrence of at least one episode of delirium (OR 5.69, p = 0.017), male sex (OR 5.10, p < 0.0001), and CURB-65 score (OR 3.98, p < 0.0001). Several predictors of in-hospital death (COPD, male gender, CURB-65) in patients with CAP older than 65 years are similar to those of younger patients. In this cohort of elderly patients, the occurrence of delirium was highly prevalent and represented a distinctive predictor of death.
社区获得性肺炎（CAP）是老年人住院和死亡的常见原因。在普通CAP人群中，已经对许多院内结局的预测因素进行了研究。然而，关于老年患者特有的情况（如谵妄和多种合并症并存）的预后意义的数据尚缺乏。本研究的目的是评估因CAP住院的老年患者院内结局的预测因素。在这项回顾性研究中，2011年1月至2012年6月期间，在两个普通病房连续纳入了年龄≥65岁的CAP患者。从电子病历中收集临床和实验室特征。研究的终点是院内死亡的发生。共纳入443例患者（平均年龄81.8±7.5岁，范围65 - 99岁）。31%的患者存在3种以上合并症。平均意识模糊、血尿素氮、呼吸频率、血压及年龄≥65岁（CURB - 65）评分是2.5±0.7分。平均住院时间为7.6±5.7天。54例患者（12.2%）发生院内死亡。多因素分析显示，院内死亡的独立预测因素为：慢性阻塞性肺疾病（COPD）（比值比[OR] 6.21，p = 0.005）、至少发生一次谵妄（OR 5.69，p = 0.017）、男性（OR 5.10，p < 0.0001）及CURB - 65评分（OR 3.98，p < 0.0001）。65岁以上CAP患者的几种院内死亡预测因素（COPD、男性、CURB - 65）与年轻患者相似。在这组老年患者中，谵妄的发生率很高，是死亡的一个独特预测因素。
