Department of Critical Care Medicine, the Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China.
Department of Respiratory Medicine, the Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China.
Ann Palliat Med. 2021 Oct;10(10):10913-10921. doi: 10.21037/apm-21-2537.
Severe community-acquired pneumonia (SCAP) is a serious health threat in elderly individuals, and a prospective, observational study was conducted to explore the prognostic factors.
Patients (≥65 years old) with SCAP that had an intensive care unit (ICU) stay >24 h were recruited at our center. Clinical and laboratory data were collected and various assessment scores were calculated. The follow-up period was censored at the date of death or at hospital discharge, whichever came first.
A total of 120 elderly patients with SCAP were included. Among them, 61 were cured (survival group) and 59 died due to SCAP (mortality group). Multivariate logistic regression analysis showed that chronic obstructive pulmonary disorder (COPD, β=2.061, P=0.008) and CD3+CD4+ T cell count (β=-0.019, P=0.017) were independent prognostic factors for death in elderly patients with SCAP. The area under the receiver operating characteristic (ROC) curve (AUROC) for the age- and gender-adjusted model was estimated to be 0.915 [95% confidence interval (CI): 0.858-0.972] for mortality, and the sensitivity and specificity of the model were 91.53% and 86.89%, respectively.
Our findings suggest that COPD and the CD3+CD4+ T cell count are independent prognostic factors for mortality, and the constructed model was moderately accurate in the prediction of mortality for elderly patients with SCAP.
重症社区获得性肺炎（SCAP）是老年人的严重健康威胁，本前瞻性观察研究旨在探讨其预后因素。
在我院，对入住重症监护病房（ICU）>24 h 的重症社区获得性肺炎（SCAP）老年患者进行前瞻性观察研究。收集临床和实验室数据，并计算各种评估评分。随访时间截止于死亡或出院，以先到者为准。
共纳入 120 例老年重症社区获得性肺炎患者，其中 61 例治愈（生存组），59 例因 SCAP 死亡（死亡组）。多因素 logistic 回归分析显示，慢性阻塞性肺疾病（COPD，β=2.061，P=0.008）和 CD3+CD4+T 细胞计数（β=-0.019，P=0.017）是老年重症社区获得性肺炎患者死亡的独立预后因素。年龄和性别校正模型的受试者工作特征（ROC）曲线下面积（AUROC）估计值为 0.915[95%置信区间（CI）：0.858-0.972]，模型的灵敏度和特异度分别为 91.53%和 86.89%。
本研究表明，COPD 和 CD3+CD4+T 细胞计数是死亡的独立预后因素，构建的模型对老年重症社区获得性肺炎患者的死亡率有较好的预测价值。
