Yuan Jia, Liu Ying, Liu Di, Wang Difen, Shen Feng, Liu Xu, Li Shuwen, He Dehua
Department of Critical Care Medicine, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou, China.
School of Journalism and Communication, National Digital Health Research Center, China Institute of Education and Social Development, Beijing Normal University, Beijing 100875, China. Corresponding author: Liu Ying, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2023 Jan;35(1):66-70. doi: 10.3760/cma.j.cn121430-20220309-00231.
To analyze the factors influencing pulmonary infections in elderly neurocritical patients in the intensive care unit (ICU) and to explore the predictive value of risk factors for pulmonary infections.
The clinical data of 713 elderly neurocritical patients [age ≥ 65 years, Glasgow coma score (GCS) ≤ 12 points] admitted to the department of critical care medicine of the Affiliated Hospital of Guizhou Medical University from 1 January 2016 to 31 December 2019 were retrospectively analyzed. According to whether or not they had HAP, the elderly neurocritical patients were divided into hospital-acquired pneumonia (HAP) group and non-HAP group. The differences in baseline data, medication and treatment, and outcome indicators between the two groups were compared. Logistic regression analysis was used to analyze the factors influencing the occurrence of pulmonary infection. The receiver operator characteristic curve (ROC curve) was plotted for risk factors and a predictive model was constructed to evaluate the predictive value for pulmonary infection.
A total of 341 patients were enrolled in the analysis, including 164 non-HAP patients and 177 HAP patients. The incidence of HAP was 51.91%. According to univariate analysis, compared with the non-HAP group, mechanical ventilation time, the length of ICU stay and total hospitalization in the HAP group were significantly longer [mechanical ventilation time (hours): 171.00 (95.00, 273.00) vs. 60.17 (24.50, 120.75), the length of ICU stay (hours): 263.50 (160.00, 409.00) vs. 114.00 (77.05, 187.50), total hospitalization (days): 29.00 (13.50, 39.50) vs. 27.00 (11.00, 29.50), all P < 0.01], the proportion of open airway, diabetes, proton pump inhibitor (PPI), sedative, blood transfusion, glucocorticoids, and GCS ≤ 8 points were significantly increased than those in HAP group [open airway: 95.5% vs. 71.3%, diabetes: 42.9% vs. 21.3%, PPI: 76.3% vs. 63.4%, sedative: 93.8% vs. 78.7%, blood transfusion: 57.1% vs. 29.9%, glucocorticoids: 19.2% vs. 4.3%, GCS ≤ 8 points: 83.6% vs. 57.9%, all P < 0.05], prealbumin (PA) and lymphocyte count (LYM) decreased significantly [PA (g/L): 125.28±47.46 vs. 158.57±54.12, LYM (×10/L): 0.79 (0.52, 1.23) vs. 1.05 (0.66, 1.57), both P < 0.01]. Logistic regression analysis showed that open airway, diabetes, blood transfusion, glucocorticoids and GCS ≤ 8 points were independent risk factors for pulmonary infection in elderly neurocritical patients [open airway: odds ratio (OR) = 6.522, 95% confidence interval (95%CI) was 2.369-17.961; diabetes: OR = 3.917, 95%CI was 2.099-7.309; blood transfusion: OR = 2.730, 95%CI was 1.526-4.883; glucocorticoids: OR = 6.609, 95%CI was 2.273-19.215; GCS ≤ 8 points: OR = 4.191, 95%CI was 2.198-7.991, all P < 0.01], and LYM, PA were the protective factors for pulmonary infection in elderly neurocritical patients (LYM: OR = 0.508, 95%CI was 0.345-0.748; PA: OR = 0.988, 95%CI was 0.982-0.994, both P < 0.01). ROC curve analysis showed that the area under the ROC curve (AUC) for predicting HAP using the above risk factors was 0.812 (95%CI was 0.767-0.857, P < 0.001), with a sensitivity of 72.3% and a specificity of 78.7%.
Open airway, diabetes, glucocorticoids, blood transfusion, GCS ≤ 8 points are independent risk factors for pulmonary infection in elderly neurocritical patients. The prediction model constructed by the above mentioned risk factors has certain predictive value for the occurrence of pulmonary infection in elderly neurocritical patients.
分析重症监护病房（ICU）老年神经重症患者肺部感染的影响因素，探讨危险因素对肺部感染的预测价值。
回顾性分析2016年1月1日至2019年12月31日贵州医科大学附属医院重症医学科收治的713例老年神经重症患者[年龄≥65岁，格拉斯哥昏迷评分（GCS）≤12分]的临床资料。根据是否发生医院获得性肺炎（HAP），将老年神经重症患者分为医院获得性肺炎（HAP）组和非HAP组。比较两组患者的基线资料、用药及治疗情况和结局指标。采用Logistic回归分析影响肺部感染发生的因素。绘制危险因素的受试者工作特征曲线（ROC曲线），构建预测模型，评估其对肺部感染的预测价值。
共纳入341例患者进行分析，其中非HAP患者164例，HAP患者177例。HAP发生率为51.91%。单因素分析显示，与非HAP组比较，HAP组机械通气时间、ICU住院时间和总住院时间显著延长[机械通气时间（小时）：171.00（95.00，273.00）比60.17（24.50，120.75），ICU住院时间（小时）：263.50（160.00，409.00）比114.00（77.05，187.50），总住院时间（天）：29.00（13.50，39.50）比27.00（11.00，29.50），均P<0.01]，气道开放、糖尿病、质子泵抑制剂（PPI）、镇静剂、输血、糖皮质激素使用比例及GCS≤8分的比例均显著高于非HAP组[气道开放：95.5%比71.3%，糖尿病：42.9%比21.3%，PPI：76.3%比63.4%，镇静剂：93.8%比78.7%，输血：57.1%比29.9%，糖皮质激素：19.2%比4.3%，GCS≤8分：83.6%比57.9%，均P<0.05]，前白蛋白（PA）和淋巴细胞计数（LYM）显著降低[PA（g/L）：125.28±47.46比158.57±54.12，LYM（×10/L）：0.79（0.52，1.23）比1.05（0.66，1.57），均P<0.01]。Logistic回归分析显示，气道开放、糖尿病、输血、糖皮质激素使用及GCS≤8分是老年神经重症患者肺部感染的独立危险因素[气道开放：比值比（OR）=6.522，95%置信区间（95%CI）为2.369 - 17.961；糖尿病：OR = 3.917，95%CI为2.099 - 7.309；输血：OR = 2.730，95%CI为1.526 - 4.883；糖皮质激素：OR = 6.609，95%CI为2.273 - 19.215；GCS≤8分：OR = 4.191，95%CI为2.198 - 7.991，均P<0.01]，LYM、PA是老年神经重症患者肺部感染的保护因素（LYM：OR = 0.508，95%CI为0.345 - 0.748；PA：OR = 0.988，95%CI为0.982 - 0.994，均P<0.01）。ROC曲线分析显示，采用上述危险因素预测HAP的ROC曲线下面积（AUC）为0.812（95%CI为0.767 - 0.857，P<0.001），敏感度为72.3%，特异度为78.7%。
气道开放、糖尿病、糖皮质激素使用、输血、GCS≤8分是老年神经重症患者肺部感染的独立危险因素。由上述危险因素构建的预测模型对老年神经重症患者肺部感染的发生具有一定预测价值。
