入院时的日常生活活动能力是老年社区获得性肺炎患者院内死亡率的独立预测因素。
Activity of daily living upon admission is an independent predictor of in-hospital mortality in older patients with community-acquired pneumonia.
机构信息
Department of Internal Medicine, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China.
Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
出版信息
BMC Infect Dis. 2021 Apr 1;21(1):314. doi: 10.1186/s12879-021-06006-w.
BACKGROUND
Older patients hospitalized with community-acquired pneumonia (CAP) are at high risk for short-term mortality. Activity of daily living (ADL) is associated with clinical outcomes in older patients. We aimed to investigate the prognostic value of ADL upon admission on the in-hospital mortality in older patients with CAP.
METHODS
We conducted a retrospective cohort study involving patients aged ≥65 years admitted to Beijing Chao-Yang hospital due to CAP between June 2012 and June 2020. ADL evaluation upon admission was performed by Barthel Index (BI). Data from all patients were extracted from the electronic medical records.
RESULTS
Four thousand eight hundred eighty patients were included, 131 patients (2.7%) died during their hospitalization. Median BI in the Deceased group was 45 (20-65), Deceased group had lower BI scores than Survivors group (p < 0.001). Low BI (< 60) was more frequent in patients who died in the hospital than in patients discharged alive (69.5% vs. 13%, p < 0.001). In-hospital mortality was higher among patients with worse ADL upon admission (BI< 60) compared to those BI≥60 (12.6% vs. 0.9%). The worse ADL upon admission (BI< 60) was associated with an increase in the risk of death during CAP hospitalization, worse ADL upon admission (BI< 60) showed an odds ratio (OR) for in-hospital mortality of 7.53 (95%CI: 2.77-20.48; P < 0.01). This association remained significant after adjustment for age, comorbid conditions, respiratory failure, pathogens and laboratory findings (OR, 3.74; 95%CI, 2.37-5.91; P < 0.01). Receiver operating characteristic (ROC) curve revealed that BI upon admission is a predictor related to in-hospital mortality in elderly patients, the area under the ROC curve of BI in predicting in-hospital mortality was 0.81 (with 95% confidence interval: 0.78-0.85). The predictive value of ADL upon admission was better than age in our study population.
CONCLUSION
Activity of daily living upon admission is an independent predictor of in-hospital mortality in older patients with community-acquired pneumonia.
背景
患有社区获得性肺炎（CAP）的老年住院患者短期死亡率较高。日常生活活动（ADL）与老年患者的临床结局相关。我们旨在研究 CAP 老年患者入院时 ADL 对住院死亡率的预后价值。
方法
我们进行了一项回顾性队列研究，纳入了 2012 年 6 月至 2020 年 6 月期间因 CAP 在北京朝阳医院住院的年龄≥65 岁的患者。入院时通过 Barthel 指数（BI）评估 ADL。从电子病历中提取所有患者的数据。
结果
共纳入 4880 例患者，其中 131 例（2.7%）在住院期间死亡。死亡组的 BI 中位数为 45（20-65），死亡组的 BI 评分低于存活组（p<0.001）。与存活出院的患者相比，住院期间死亡的患者 BI<60 的比例更高（69.5% vs. 13%，p<0.001）。入院时 ADL 较差（BI<60）的患者住院期间死亡率较高，而 ADL 较好（BI≥60）的患者死亡率较低（12.6% vs. 0.9%）。入院时 ADL 较差（BI<60）与 CAP 住院期间死亡风险增加相关，入院时 ADL 较差（BI<60）的住院死亡率优势比（OR）为 7.53（95%CI：2.77-20.48；P<0.01）。在校正年龄、合并症、呼吸衰竭、病原体和实验室发现后，这种关联仍然显著（OR，3.74；95%CI，2.37-5.91；P<0.01）。受试者工作特征（ROC）曲线显示 BI 入院时是老年患者住院死亡率相关的预测因素，BI 预测住院死亡率的 ROC 曲线下面积为 0.81（95%置信区间：0.78-0.85）。在我们的研究人群中，入院时 ADL 的预测价值优于年龄。
结论
入院时的日常生活活动是社区获得性肺炎老年患者住院死亡率的独立预测因素。
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