Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Fukuoka, Japan.
PLoS One. 2023 Sep 8;18(9):e0291233. doi: 10.1371/journal.pone.0291233. eCollection 2023.
Spontaneous pneumothorax occurs predominantly in young males and older adults, often as a secondary condition, and can be refractory and fatal. This study aimed to investigate the mortality and prognostic factors for pneumothorax in older patients. We retrospectively cohort studied patients with pneumothorax aged ≥65 years who visited our department from October 2012 to January 2019. Data on sex, age, medical history, smoking history, underlying lung disease, treatment, and prognosis were extracted from medical records. Cox proportional hazards regression analysis was used to investigate pneumothorax mortality and prognostic factors. In total, 239 patients were included. Among them, 36 (15%) died during hospitalization. Respiratory disease was the direct cause of death in 30 patients (83.3%), and 211 (88.3%) patients had underlying lung disease. The incidence of pneumonia in our hospital was 22.6% (54 cases). On admission, the mortality rate was 33% (18/54) in patients with concomitant pneumonia; univariate analysis showed significant differences in the Charlson Comorbidity Index (CCI), activities of daily living (ADL), and concomitant pneumonia. In the Cox proportional hazards analysis of ADL (p = 0.09), CCI (p = 0.05), and concomitant pneumonia on admission (p = 0.02), concomitant pneumonia on admission was found to be an independent predictor of in-hospital mortality. This study suggests that concomitant pneumonia at admission may be a mortality risk factor for pneumothorax.
自发性气胸主要发生在年轻男性和老年患者中，常为继发疾病，可导致难治性气胸甚至死亡。本研究旨在探讨老年气胸患者的死亡率和预后因素。我们回顾性分析了 2012 年 10 月至 2019 年 1 月期间因气胸就诊于我院且年龄≥65 岁的患者。从病历中提取性别、年龄、病史、吸烟史、基础肺部疾病、治疗和预后等数据。采用 Cox 比例风险回归分析探讨气胸死亡率和预后因素。共纳入 239 例患者，其中 36 例（15%）在住院期间死亡。呼吸疾病是 30 例患者（83.3%）死亡的直接原因，211 例（88.3%）患者有基础肺部疾病。我院肺炎发病率为 22.6%（54 例）。入院时，同时患有肺炎的患者死亡率为 33%（18/54）；单因素分析显示，Charlson 合并症指数（CCI）、日常生活活动能力（ADL）和同时患有肺炎差异有统计学意义。在 ADL（p=0.09）、CCI（p=0.05）和入院时同时患有肺炎（p=0.02）的 Cox 比例风险分析中，入院时同时患有肺炎被发现是住院期间死亡率的独立预测因素。本研究表明，入院时同时患有肺炎可能是气胸患者死亡的风险因素。
