Taooka Yasuyuki, Takezawa Gen, Ohe Miki, Sutani Akihisa, Isobe Takeshi
Department of General Medicine, Aki-Ohta Hospital, Shimodono-Gohchi 236, Aki-Ohta-Cho, Yamagata-Gun, Hiroshima, 731-3622 Japan ; Division of Clinical Oncology and Respiratory Medicine, Department of Internal Medicine, Shimane University Faculty of Medicine, Izumo, Japan.
Department of General Medicine, Aki-Ohta Hospital, Shimodono-Gohchi 236, Aki-Ohta-Cho, Yamagata-Gun, Hiroshima, 731-3622 Japan.
Multidiscip Respir Med. 2014 Nov 22;9(1):59. doi: 10.1186/2049-6958-9-59. eCollection 2014.
Acute pneumonia is a serious problem in the elderly and various risk factors have already been reported, but the involvement of QTc interval prolongation remains uncertain. The aim of this study was to elucidate the prognostic factors for the development of pneumonia in elderly patients and to study the possible involvement of QTc interval prolongation.
The subjects were 249 hospitalized pneumonia patients more than 65 years old in Aki-Ohta Hospital from January 2010 to December 2013. Community-acquired pneumonia patients and nursing care and healthcare-associated pneumonia patients were included in the study. The pneumonia severity index, vital signs, blood chemistry data and ECG findings were retrospectively compared using multiple logistic regression analysis.
39 patients died within 30 days from onset. The clinical features related to poor prognosis were: advanced age, past history of cerebral vascular disease and/or diabetes mellitus, decreased serum albumin level, higher CURB-65 or PORT index scores and QTc interval prolongation. Patients showing a prolonged QTc interval had a higher mortality than those with a normal QTc interval. A prolonged QTc interval was not related to serum calcium concentration and/or treatment with QTc prolongation drug, clarithromycin or azithromycin, but related to age, lower albumin concentration and past history of diabetes mellitus.
These findings suggest potential prognostic factors for pneumonia in elderly patients, including a prolonged QTc interval (> 0.44 seconds).
急性肺炎在老年人中是一个严重问题，已有多种危险因素被报道，但QTc间期延长的影响仍不明确。本研究的目的是阐明老年患者肺炎发生的预后因素，并研究QTc间期延长可能的影响。
研究对象为2010年1月至2013年12月在秋田太田医院住院的249例65岁以上的肺炎患者。研究纳入社区获得性肺炎患者以及护理和医疗保健相关肺炎患者。采用多因素逻辑回归分析对肺炎严重程度指数、生命体征、血液化学数据和心电图结果进行回顾性比较。
39例患者在发病后30天内死亡。与预后不良相关的临床特征为：高龄、既往有脑血管疾病和/或糖尿病史、血清白蛋白水平降低、CURB - 65或PORT指数评分较高以及QTc间期延长。QTc间期延长的患者死亡率高于QTc间期正常的患者。QTc间期延长与血清钙浓度和/或使用QTc延长药物（克拉霉素或阿奇霉素）治疗无关，但与年龄、较低的白蛋白浓度和糖尿病史有关。
这些发现提示老年患者肺炎的潜在预后因素，包括QTc间期延长（>0.44秒）。
