Kosai Kosuke, Izumikawa Koichi, Imamura Yoshifumi, Tanaka Hironori, Tsukamoto Misuzu, Kurihara Shintaro, Takazono Takahiro, Morinaga Yoshitomo, Nakamura Shigeki, Miyazaki Taiga, Yanagihara Katsunori, Tashiro Takayoshi, Kohno Shigeru
Nijigaoka Hospital, Japan.
Intern Med. 2014;53(15):1613-20. doi: 10.2169/internalmedicine.53.2499. Epub 2014 Aug 1.
In Japan, the number of elderly people who have difficulties performing the activities of daily living (ADLs) is increasing. The objective of this study was to assess the relationship between ADL and the clinical characteristics of pneumonia.
We conducted a retrospective study of 219 adult patients hospitalized due to pneumonia [151 patients with community-acquired pneumonia (CAP) and 68 patients with healthcare-associated pneumonia (HCAP)]. CAP, HCAP, and all the patients were stratified into two groups using a modified version of the Katz index of five ADLs as follows: independent in all ADLs or dependent in one to three ADLs (CAP-A, HCAP-A, and All-A groups) and dependent in four or five ADLs (CAP-B, HCAP-B, and All-B groups). Disease severity, microbiological findings, and mortality were compared between the groups.
As the ability to perform ADLs declined, A-DROP scores (the CAP severity measurement index) increased significantly in CAP (CAP-A: 1.1±1.1, CAP-B: 2.6±1.1), HCAP (HCAP-A: 2.0±1.0, HCAP-B: 2.8±1.0), and all patients (All-A: 1.3±1.1, All-B: 2.8±1.0). Thirty-day mortality was higher in the CAP-B (23.1%) and All-B (19.2%) groups than in the CAP-A (0.7%) and All-A (1.8%) groups, respectively. A multivariate Cox proportional hazards analysis showed an ADL score ≥ four to be a significant predictor of 30-day mortality in CAP patients [hazard ratio (HR), 19.057; 95% confidence interval (CI), 1.930-188.130] and in all patients (HR, 8.180; 95% CI, 1.998-33.494).
A functional assessment using a modified version of the Katz index is useful for the management of CAP and HCAP patients.
在日本，日常生活活动（ADL）存在困难的老年人数量正在增加。本研究的目的是评估ADL与肺炎临床特征之间的关系。
我们对219例因肺炎住院的成年患者进行了一项回顾性研究[151例社区获得性肺炎（CAP）患者和68例医疗保健相关肺炎（HCAP）患者]。使用改良版的Katz五项ADL指数将CAP、HCAP和所有患者分为两组，如下：所有ADL均独立或一至三项ADL依赖（CAP-A、HCAP-A和All-A组）以及四项或五项ADL依赖（CAP-B、HCAP-B和All-B组）。比较各组之间的疾病严重程度、微生物学检查结果和死亡率。
随着ADL执行能力下降，CAP（CAP-A：1.1±1.1，CAP-B：2.6±1.1）、HCAP（HCAP-A：2.0±1.0，HCAP-B：2.8±1.0）和所有患者（All-A：1.3±1.1，All-B：2.8±1.0）的A-DROP评分（CAP严重程度测量指标）显著增加。CAP-B组（23.1%）和All-B组（19.2%）的30天死亡率分别高于CAP-A组（0.7%）和All-A组（1.8%）。多因素Cox比例风险分析显示ADL评分≥4是CAP患者[风险比（HR），19.057；95%置信区间（CI），1.930 - 188.130]和所有患者（HR，8.180；95%CI，1.998 - 33.494）30天死亡率的显著预测因素。
使用改良版Katz指数进行功能评估对CAP和HCAP患者的管理有用。
