Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
Division of Otolaryngology, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Japan.
PLoS One. 2021 Jul 30;16(7):e0254261. doi: 10.1371/journal.pone.0254261. eCollection 2021.
Pneumonia is a common cause of illness and death of the elderly in Japan. Its prevalence is escalating globally with the aging of population. To describe the latest trends in pneumonia hospitalizations, especially aspiration pneumonia (AP) cases, we assessed the clinical records of pneumonia patients admitted to core acute care hospitals in Miyagi prefecture, Japan.
A retrospective multi-institutional joint research was conducted for hospitalized pneumonia patients aged ≥20 years from January 2019 to December 2019. Clinical data of patients were collected from the medical records of eight acute care hospitals.
Out of the 1,800 patients included in this study, 79% of the hospitalized pneumonia patients were aged above 70 years. The most common age group was in the 80s. The ratio of AP to total pneumonia cases increased with age, and 692 out of 1,800 patients had AP. In univariate analysis, these patients had significantly older ages, lower body mass index (BMI), a lower ratio of normal diet intake and homestay before hospitalization, along with more AP recurrences and comorbidities. During hospitalization, AP patients had extended fasting periods, more swallowing assessments and interventions, longer hospitalization, and higher in-hospital mortality rate than non-AP patients. A total of 7% and 2% AP patients underwent video endoscopy and video fluorography respectively. In multivariate analysis, lower BMI, lower C-reactive protein, a lower ratio of homestay before hospitalization, a higher complication rate of cerebrovascular disease, dementia, and neuromuscular disease were noted as a characteristic of AP patients. Swallowing interventions were performed for 51% of the AP patients who had been hospitalized for more than two weeks. In univariate analysis, swallowing intervention improved in-hospital mortality. Lower AP recurrence before hospitalization and a lower ratio of homestay before hospitalization were indicated as characteristics of AP patients of the swallowing intervention group from multivariate analysis. Change in dietary pattern from normal to modified diet was observed more frequently in the swallowing intervention group.
AP accounts for 38.4% of all pneumonia cases in acute care hospitals in Northern Japan. The use of swallowing evaluations and interventions, which may reduce the risk of dysphagia and may associate with lowering mortality in AP patients, is still not widespread.
肺炎是导致日本老年人患病和死亡的常见原因。随着人口老龄化，全球肺炎发病率呈上升趋势。为了描述肺炎住院的最新趋势，特别是吸入性肺炎（AP）病例，我们评估了日本宫城县核心急症护理医院收治的肺炎患者的临床记录。
对 2019 年 1 月至 2019 年 12 月期间入住的年龄≥20 岁的住院肺炎患者进行回顾性多机构联合研究。从 8 家急症护理医院的病历中收集患者的临床数据。
在纳入的 1800 名患者中，79%的住院肺炎患者年龄在 70 岁以上。最常见的年龄组在 80 多岁。AP 占总肺炎病例的比例随年龄增长而增加，1800 名患者中有 692 名患有 AP。在单变量分析中，这些患者年龄明显较大，体重指数（BMI）较低，住院前正常饮食摄入和居家护理的比例较低，且 AP 复发和合并症较多。住院期间，AP 患者禁食时间延长，吞咽评估和干预次数增加，住院时间延长，院内死亡率较高。分别有 7%和 2%的 AP 患者接受了视频内镜和视频荧光检查。多变量分析显示，BMI 较低、C 反应蛋白较低、住院前居家护理比例较低、脑血管病、痴呆和神经肌肉疾病并发症发生率较高是 AP 患者的特征。51%住院时间超过两周的 AP 患者接受了吞咽干预。在单变量分析中，吞咽干预改善了院内死亡率。多变量分析显示，住院前 AP 复发率较低和住院前居家护理比例较低是 AP 患者吞咽干预组的特征。从常规饮食改为改良饮食的饮食模式改变在吞咽干预组中更为常见。
日本北部急症护理医院的所有肺炎病例中，AP 占 38.4%。吞咽评估和干预的应用，可能降低吞咽困难的风险，并可能与降低 AP 患者的死亡率相关，但仍未广泛应用。
