Department of Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan; Department of Internal Medicine, Tenshindo Hetsugi Hospital, 5956 Nihongi, Nakahetsugi, Oita, Oita, 879-7761, Japan.
Department of Internal Medicine, Tenshindo Hetsugi Hospital, 5956 Nihongi, Nakahetsugi, Oita, Oita, 879-7761, Japan.
J Infect Chemother. 2024 Feb;30(2):129-133. doi: 10.1016/j.jiac.2023.09.027. Epub 2023 Sep 26.
It has not been fully elucidated that nutritional parameters affect the change of activities of daily living (ADL) during pneumonia treatment. This study assessed the impact of nutritional status, including erector spinae muscle (ESM) size on ADL changes from admission to discharge among older patients with community-acquired pneumonia (CAP).
We retrospectively included patients (age: ≥65 years) who were admitted to the hospital for CAP and underwent chest computed tomography (CT) on admission. ADL was evaluated using the Barthel index, and patients were divided into the maintained or improved ADL group and the declined ADL group from admission through discharge. The ESM cross-sectional area was measured on a single-slice CT image. Logistic regression models were applied for assessing factors associated with changes in ADL.
A total of 523 patients hospitalized for CAP (median age 86 years) were evaluated. The declined group had significantly higher ADL levels on admission, a greater frequency of smoking history and malignancy, and a lower frequency of cerebrovascular disease and dementia. No significant difference in ESM size was observed between the groups. Multivariate analysis revealed that higher ADL levels on admission (odds ratio 1.034, interquartile range 1.026-1.043) and malignancy (3.002, 1.150-7.836) were associated with a decline in ADL, whereas cerebrovascular disease (0.579, 0.373-0.900) was related to improvement or maintenance of ADL.
Although nutritional status might not affect the change of ADL among older patients hospitalized with pneumonia, a cerebrovascular disease history may be a good predictor for ADL improvement.
目前尚未充分阐明营养参数会影响肺炎治疗过程中日常生活活动（ADL）的变化。本研究评估了营养状况（包括竖脊肌（ESM）大小）对社区获得性肺炎（CAP）老年患者入院至出院期间 ADL 变化的影响。
我们回顾性纳入因 CAP 住院且入院时接受胸部计算机断层扫描（CT）的患者（年龄≥65 岁）。ADL 通过 Barthel 指数进行评估，并根据入院至出院期间 ADL 的维持或改善情况将患者分为 ADL 保持或改善组和 ADL 下降组。在单次 CT 图像上测量 ESM 横截面积。应用逻辑回归模型评估与 ADL 变化相关的因素。
共评估了 523 例因 CAP 住院的患者（中位年龄 86 岁）。ADL 下降组入院时 ADL 水平明显较高，吸烟史和恶性肿瘤的发生率较高，而脑血管疾病和痴呆的发生率较低。两组 ESM 大小无显著差异。多变量分析显示，入院时较高的 ADL 水平（优势比 1.034，四分位间距 1.026-1.043）和恶性肿瘤（3.002，1.150-7.836）与 ADL 下降相关，而脑血管疾病（0.579，0.373-0.900）与 ADL 改善或维持相关。
尽管营养状况可能不会影响肺炎住院老年患者 ADL 的变化，但脑血管疾病史可能是 ADL 改善的良好预测指标。
