Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan.
Respirology. 2024 Aug;29(8):722-730. doi: 10.1111/resp.14752. Epub 2024 May 20.
The identification of factors associated with long-term prognosis after community-onset pneumonia in elderly patients should be considered when initiating advance care planning (ACP). We aimed to identify these factors and develop a prediction score model.
Patients aged 65 years and older, who were hospitalized for pneumonia at nine collaborating institutions, were included. The prognosis of patients 180 days after the completion of antimicrobial treatment for pneumonia was prospectively collected.
The total number of analysable cases was 399, excluding 7 outliers and 42 cases with missing data or unknown prognosis. These cases were randomly divided in an 8:2 ratio for score development and testing. The median age was 82 years, and there were 68 (17%) deaths. A multivariate analysis showed that significant factors were performance status (PS) ≥2 (Odds ratio [OR], 11.78), hypoalbuminemia ≤2.5 g/dL (OR, 5.28) and dementia (OR, 3.15), while age and detection of antimicrobial-resistant bacteria were not associated with prognosis. A scoring model was then developed with PS ≥2, Alb ≤2.5, and dementia providing scores of 2, 1 and 1 each, respectively, for a total of 4. The area under the curve was 0.8504, and the sensitivity and specificity were 94.6% and 61.7% at the cutoff of 2, respectively. In the test cases, the sensitivity and specificity were 91.7% and 63.1%, respectively, at a cutoff value of 2.
Patients meeting this score should be considered near the end of life, and the initiation of ACP practices should be considered.
在启动预先护理计划（ACP）时，应考虑识别与老年社区获得性肺炎患者长期预后相关的因素。我们旨在确定这些因素并开发预测评分模型。
纳入在 9 家合作机构因肺炎住院的年龄在 65 岁及以上的患者。前瞻性收集肺炎抗菌治疗完成后 180 天患者的预后。
排除 7 个离群值和 42 例缺失数据或预后未知的病例后，共分析了 399 例可分析病例。这些病例以 8:2 的比例随机分为评分开发和测试组。中位年龄为 82 岁，有 68 例（17%）死亡。多变量分析表明，显著的因素是 PS≥2（优势比 [OR]，11.78）、低白蛋白血症≤2.5g/dL（OR，5.28）和痴呆（OR，3.15），而年龄和检测到的抗菌药物耐药菌与预后无关。然后开发了一个评分模型，PS≥2、Alb≤2.5 和痴呆分别给予 2、1 和 1 分，总分为 4 分。曲线下面积为 0.8504，截距为 2 时的灵敏度和特异性分别为 94.6%和 61.7%。在测试病例中，截断值为 2 时，灵敏度和特异性分别为 91.7%和 63.1%。
符合该评分标准的患者应被视为生命末期，应考虑启动 ACP 实践。
