与肌肉量相关的临床生物标志物可预测社区获得性肺炎老年患者的死亡率。
Clinical muscle mass-related biomarkers that predict mortality in older patients with community-acquired pneumonia.
机构信息
Zigong Affiliated Hospital of Southwest Medical University, Zigong Psychiatric Research Center, Zigong, China.
出版信息
BMC Geriatr. 2022 Nov 19;22(1):880. doi: 10.1186/s12877-022-03626-y.
OBJECTIVE
Community-acquired pneumonia (CAP) is associated with elevated morbidity and mortality, and it usually occurs in older adults. Our goal here was to assess the efficacies of muscle mass-related biomarkers, such as, aspartate transaminase/alanine transaminase (AST/ALT) and creatinine/cystatin C100 (Cr/CysC100), in predicting 1-, 2-, and 3-year mortalities of older CAP patients.
METHODS
Design: Retrospective cohort study.
SETTING AND PARTICIPANTS
A teaching hospital in western China. Hospitalized CAP patients, aged≥60 years. We separated patients into a high or low muscle mass group, according to the median AST/ALT and Cr/CysC100, respectively. We acquired data from medical records and local government mortality databases, as well as telephonic interviews. We analyzed the association between low muscle mass (AST/ALT and Cr/CysC100) and all-cause mortality at 1, 2, and 3 years in older patients with CAP.
RESULTS
We enrolled 606 patients (58.58% male; median age: 81 years) for analysis. The 1-, 2-, and 3-year mortality in older patients with CAP in the low muscle mass group (AST/ALT) was higher than in the high muscle mass group (AST/ALT) (1-year: 51.16% vs. 36.96%, p < 0.001; 2-year: 54.46% vs. 41.25%, p = 0.001; 3-year: 54.79% vs. 42.9%, p = 0.003). Upon adjustment of potential confounding factors, we revealed, using cox regression analysis, that the low muscle mass group (AST/ALT) experienced enhanced mortality risk at the 1-, 2-, and 3-year follow-ups, compared to the high muscle mass group (AST/ALT) (1-year: hazard ratios (HR) = 1.46, 95% confidence interval (CI): 1.13-1.88; 2-year: HR = 1.39, 95% CI: 1.09-1.77; 3-year: HR = 1.35, 95% CI: 1.06-1.72). The 1-, 2-, and 3-year mortality of older CAP patients in the low muscle mass group (Cr/CysC100) was also higher than the high muscle mass group (Cr/CysC100) (1-year: 56.29% vs. 31.91%, p < 0.001; 2-year: 60.26% vs. 35.53%, p < 0.001; 3-year: 61.26% vs. 36.51%, p < 0.001). Compared to the high muscle mass group (Cr/CysC100), the low muscle mass group (Cr/CysC100) experienced enhanced mortality risk at the 1-, 2-, and 3-year follow ups (1-year: HR = 1.9, 95% CI: 1.46-2.48; 2-year: HR = 1.85, 95% CI: 1.44-2.39; 3-year: HR = 1.85, 95% CI: 1.44-2.37).
CONCLUSIONS
Low muscle mass (AST/ALT and Cr/CysC*100) were associated with enhanced 1-, 2-, and 3-year mortality risk in older patients with CAP.
目的
社区获得性肺炎（CAP）与发病率和死亡率升高有关，通常发生在老年人中。我们的目标是评估肌肉质量相关生物标志物（如天冬氨酸氨基转移酶/丙氨酸氨基转移酶（AST/ALT）和肌酐/胱抑素 C100（Cr/CysC100））在预测老年 CAP 患者 1 年、2 年和 3 年死亡率方面的功效。
方法
设计：回顾性队列研究。
地点和参与者
中国西部的一家教学医院。年龄≥60 岁的住院 CAP 患者。我们根据 AST/ALT 和 Cr/CysC100 的中位数将患者分为高或低肌肉量组。我们从病历、当地政府死亡率数据库和电话访谈中获取数据。我们分析了低肌肉量（AST/ALT 和 Cr/CysC100）与老年 CAP 患者 1 年、2 年和 3 年全因死亡率之间的关系。
结果
我们纳入了 606 名患者（58.58%为男性；中位年龄：81 岁）进行分析。低肌肉量组（AST/ALT）老年 CAP 患者的 1 年、2 年和 3 年死亡率高于高肌肉量组（AST/ALT）（1 年：51.16%比 36.96%，p<0.001；2 年：54.46%比 41.25%，p=0.001；3 年：54.79%比 42.9%，p=0.003）。在调整潜在混杂因素后，我们使用 Cox 回归分析发现，与高肌肉量组（AST/ALT）相比，低肌肉量组（AST/ALT）在 1 年、2 年和 3 年随访中死亡风险增加（1 年：危险比（HR）=1.46，95%置信区间（CI）：1.13-1.88；2 年：HR=1.39，95%CI：1.09-1.77；3 年：HR=1.35，95%CI：1.06-1.72）。低肌肉量组（Cr/CysC100）老年 CAP 患者的 1 年、2 年和 3 年死亡率也高于高肌肉量组（Cr/CysC100）（1 年：56.29%比 31.91%，p<0.001；2 年：60.26%比 35.53%，p<0.001；3 年：61.26%比 36.51%，p<0.001）。与高肌肉量组（Cr/CysC100）相比，低肌肉量组（Cr/CysC100）在 1 年、2 年和 3 年随访中死亡风险增加（1 年：HR=1.9，95%CI：1.46-2.48；2 年：HR=1.85，95%CI：1.44-2.39；3 年：HR=1.85，95%CI：1.44-2.37）。
结论
低肌肉量（AST/ALT 和 Cr/CysC*100）与老年 CAP 患者 1 年、2 年和 3 年死亡率增加相关。
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