Miyazaki Hiroyuki, Nagata Nobuhiko, Akagi Takanori, Takeda Satoshi, Harada Taishi, Ushijima Shinichiro, Aoyama Takashi, Yoshida Yuji, Yatsugi Hiroshi, Fujita Masaki, Watanabe Kentaro
Department of Respiratory Medicine, Fukuoka University Chikushi Hospital, Japan.
Department of Respiratory Medicine, Fukuoka University Chikushi Hospital, Japan.
J Infect Chemother. 2018 Aug;24(8):602-609. doi: 10.1016/j.jiac.2018.03.006. Epub 2018 Apr 5.
This study aimed to elucidate factors related to 30-day mortality of pneumonia occurring outside hospital by comprehensively analyzing data considered relevant to prognosis.
Data considered relevant to prognosis were retrospectively examined from clinical charts and chest X-ray images of all patients with pneumonia occurring outside hospital admitted to our hospital from 2010 to 2016. The primary outcome was 30-day mortality.
Data were collected from 534 patients (317 community-acquired pneumonia and 217 nursing- and healthcare associated pneumonia patients; 338 men (63.3%); mean age, 76.2 years-old). Eighty-three patients (9.9%) died from pneumonia within 30 days from the date of admission. The numbers of patients with pneumonia severity index (PSI) classes of I/II/III/IV/V and age, dehydration, respiratory failure, orientation disturbance, pressure (A-DROP) scores of 0/1/2/3/4/5 were 29/66/127/229/83, and 71/107/187/132/30/7, respectively. Mean (standard deviation) body mass index (BMI), serum albumin, blood procalcitonin, white blood cell and C-reactive protein were 20.00 (4.12) kg/m, 3.16 (0.60) g/dL, 3.69 (13.15) ng/mL, 11559.4 (5656.9)/mm, and 10.92 (8.75) mg/dL, respectively. Chest X-ray images from 152 patients exhibited a pneumonia shadow over a quarter of total lung field. Logistic regression analysis revealed that PSI class or A-DROP score, BMI, serum albumin, and extent of pneumonia shadow were related to 30-day mortality. Receiver operating characteristics curve analysis revealed that serum albumin was superior to PSI class or A-DROP score for predicting 30-day mortality.
Serum albumin is not less important than PSI class or A-DROP score for predicting 30-day mortality in hospitalized patients with pneumonia occurring outside hospital.
本研究旨在通过全面分析与预后相关的数据，阐明院外肺炎30天死亡率的相关因素。
回顾性研究2010年至2016年我院收治的所有院外肺炎患者的临床病历和胸部X线影像中与预后相关的数据。主要结局指标为30天死亡率。
共收集534例患者的数据（317例社区获得性肺炎患者和217例护理及医疗相关肺炎患者；男性338例（63.3%）；平均年龄76.2岁）。83例患者（9.9%）在入院后30天内死于肺炎。肺炎严重程度指数（PSI）分级为I/II/III/IV/V的患者数量以及年龄、脱水、呼吸衰竭、定向障碍、压力（A-DROP）评分为0/1/2/3/4/5的患者数量分别为29/66/127/229/83例和71/107/187/132/30/7例。平均（标准差）体重指数（BMI）、血清白蛋白、血降钙素原、白细胞和C反应蛋白分别为20.00（4.12）kg/m²、3.16（0.60）g/dL、3.69（13.15）ng/mL、11559.4（5656.9）/mm³和10.92（8.75）mg/dL。152例患者的胸部X线影像显示肺炎阴影超过全肺野的四分之一。逻辑回归分析显示，PSI分级或A-DROP评分、BMI、血清白蛋白和肺炎阴影范围与30天死亡率相关。受试者工作特征曲线分析显示，血清白蛋白在预测30天死亡率方面优于PSI分级或A-DROP评分。
对于预测院外肺炎住院患者的30天死亡率，血清白蛋白的重要性不亚于PSI分级或A-DROP评分。
