Haga Takahiro, Fukuoka Mizuki, Morita Mizuo, Cho Kohei, Tatsumi Koichiro
Division of Respiratory Medicine, Nissan Tamagawa Hospital, Japan.
Intern Med. 2016;55(5):437-41. doi: 10.2169/internalmedicine.55.5556. Epub 2016 Mar 1.
We herein assessed the utility of computed tomography (CT) for the diagnosis and ascertainment of the severity of community-acquired pneumonia (CAP) in the elderly.
The utility of CT compared with chest radiography (CR) for the diagnosis of CAP was prospectively studied among elderly inpatients with clinical symptoms and signs indicative of CAP at the Department of Respiratory Medicine in Nissan Tamagawa Hospital during the one-year period from January 2013 to December 2013. Additionally, we evaluated whether the findings of CT were useful as predictive factors related to the mortality rate associated with CAP.
One hundred and forty-two patients, 65 years of age or older, were surveyed upon hospital admission for suspected CAP. Of the 142 patients included, 127 (89.4%) had pneumonic infiltration diagnosed by CT, however, CR could not recognize pneumonic infiltration in 9.4% (12/127) of these patients. In 127 CAP-positive patients, bilateral pneumonic infiltration was more frequently detected by CT in non-survivors than survivors (79.0% vs. 53.7%; p <0.05). By a multivariable analysis to determine the prognostic factors related to mortality from CAP, oxygen desaturation showed the greatest odds ratio among the other predictive factors, followed by comorbid neoplastic disease, blood urea nitrogen ≥21 mg/dL, male gender, and bilateral pneumonic infiltration diagnosed by CT.
We herein demonstrated that CT was superior to CR for diagnosing and evaluating the severity of CAP in elderly patients.
我们在此评估计算机断层扫描（CT）在老年社区获得性肺炎（CAP）诊断及病情严重程度判定中的作用。
2013年1月至2013年12月期间，在日产玉川医院呼吸内科，对有临床症状和体征提示CAP的老年住院患者进行前瞻性研究，比较CT与胸部X线摄影（CR）在CAP诊断中的作用。此外，我们评估CT检查结果是否可作为与CAP相关死亡率的预测因素。
142例65岁及以上因疑似CAP入院的患者接受了调查。在这142例患者中，127例（89.4%）经CT诊断为肺部浸润，但CR未能识别其中9.4%（12/127）患者的肺部浸润。在127例CAP阳性患者中，非幸存者中CT检测到双侧肺部浸润的频率高于幸存者（79.0%对53.7%；p<0.05）。通过多变量分析确定与CAP死亡率相关的预后因素，在其他预测因素中，氧饱和度下降的优势比最大，其次是合并肿瘤性疾病、血尿素氮≥21mg/dL、男性以及CT诊断的双侧肺部浸润。
我们在此证明，CT在诊断和评估老年患者CAP严重程度方面优于CR。
