Yoon So Yoon, Jung Sung-Ae, Na Sun-Kyung, Ryu Jae-In, Yun Hye-Won, Lee Min-Jin, Song Eun-Mi, Kim Seong-Eun, Jung Hye-Kyung, Shim Ki-Nam
Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine, Seoul, Korea.
Intest Res. 2015 Apr;13(2):128-34. doi: 10.5217/ir.2015.13.2.128. Epub 2015 Apr 27.
BACKGROUND/AIMS: As life expectancy has increased, the number of elderly patients who need long-term care has grown rapidly. Mortality in patients with colitis in long-term care facilities (LTCFs) is increasing. We intend to investigate the main causes of colitis in LTCFs compared to those of colitis in local communities, and to identify the clinical features and risk factors of patients with colitis in LTCFs.
We retrospectively analyzed epidemiology, medical conditions, laboratory values, diagnoses, and clinical courses of elderly patients aged ≥65 who were admitted to the Ewha Womans University hospital with colitis between January 2007 and July 2012.
Patients with colitis in LTCFs (n=20) were compared with elderly patients with colitis in local communities (n=154). Fifty-five percent of colitis in LTCFs was caused by Clostridium difficile infection (CDI), 30% was due to ischemic colitis, and 15% was due to non-specific colitis. Non-specific colitis was the most common (63%) in the community group. Clinical outcomes were also significantly different between both groups: higher mortality (10.0% vs. 0.64%, P=0.021), higher requirement for intensive care units care (50.0% vs. 18.8%, P<0.01) in LTCFs group. In univariate analysis, the most significant risk factor for death in patients in LTCFs was decreased mental faculties.
Patients in LTCFs showed worse clinical outcomes and a much higher prevalence of CDI compared to patients from local communities. We suggest early and active evaluation, such as endoscopic examination, for differential diagnosis in patients in LTCFs.
背景/目的：随着预期寿命的增加，需要长期护理的老年患者数量迅速增长。长期护理机构（LTCF）中结肠炎患者的死亡率正在上升。我们旨在调查LTCF中结肠炎的主要病因，并与当地社区的结肠炎病因进行比较，同时确定LTCF中结肠炎患者的临床特征和危险因素。
我们回顾性分析了2007年1月至2012年7月间因结肠炎入住梨花女子大学医院的65岁及以上老年患者的流行病学、医疗状况、实验室检查值、诊断和临床病程。
将LTCF中的结肠炎患者（n = 20）与当地社区的老年结肠炎患者（n = 154）进行比较。LTCF中55%的结肠炎由艰难梭菌感染（CDI）引起，30%由缺血性结肠炎引起，15%由非特异性结肠炎引起。非特异性结肠炎在社区组中最为常见（63%）。两组的临床结局也有显著差异：LTCF组的死亡率更高（10.0%对0.64%，P = 0.021），重症监护病房护理需求更高（50.0%对18.8%，P < 0.01）。在单因素分析中，LTCF患者死亡的最显著危险因素是智力下降。
与当地社区的患者相比，LTCF中的患者临床结局更差，CDI患病率更高。我们建议对LTCF中的患者进行早期和积极的评估，如内镜检查，以进行鉴别诊断。
