Li Shasha, Li Lu, Wang Shengyu, Wu Hao
Department of Nephrology, First Affiliated Hospital of Xi'an Medical University, Xi'an, Shaanxi, China.
Department of Respiratory, First Affiliated Hospital of Xi'an Medical University, Xi'an, Shaanxi, China.
Front Med (Lausanne). 2025 Mar 19;12:1512288. doi: 10.3389/fmed.2025.1512288. eCollection 2025.
Community-acquired pneumonia (CAP) leads to high morbidity and mortality among the elderly, with 3 million deaths annually worldwide. Multiple comorbidities significantly increase the risk. This study aims to identify independent risk factors for mortality in elderly patients with CAP to optimize individualized treatment strategies.
This single-center retrospective study was conducted at First Affiliated Hospital of Xi'an Medical University. Clinical data from elderly patients diagnosed with CAP between December 2018 and December 2023 were retrospectively collected. Logistic regression analysis was used to determine risk factors for in-hospital mortality. A nomogram was constructed based on the final model for risk assessment.
A total of 613 eligible patients were included, with 68.2% being male, and a median age of 78 (IQR 70-86) years. The prevalence of hypertension, coronary heart disease (CHD), stroke, diabetes, malignancy, and chronic obstructive pulmonary disease (COPD) was 55.5, 39.8, 29.5, 27, 16.6, and 7%, respectively. The in-hospital mortality rate was 48%. Compared to survivors, non-survivors were older, had a higher proportion of males, faster heart rates, and higher rates of comorbidities. Multivariate logistic regression analysis identified age (OR 1.05, 95% CI [1.02-1.07], < 0.01), BMI (OR 0.92, 95% CI [0.86-0.98], < 0.01), stroke (OR 2.21, 95% [1.43-3.42], < 0.01), ARDS (OR 4.0, 95% CI [2.17-7.37], < 0.01), AKI (OR 2.98, 95% CI [1.77-5.01], < 0.01), malignancy (OR 2.11, 95% CI [1.22-3.65], < 0.01), elevated WBC (OR 1.20, 95% [1.14-1.27], < 0.01), PLT (OR 0.995, 95% CI [0.993-0.998], < 0.01), and albumin (OR 0.93, 95% CI [0.90-0.97], < 0.01) as independent risk factors for in-hospital mortality. The area under the curve (AUC) of the multivariable model was 0.85 (95% CI [0.81-0.87], < 0.01).
Elderly CAP patients have a high prevalence of comorbidities and a high in-hospital mortality rate. Advanced age, low BMI, stroke, ARDS, AKI, malignancy, elevated WBC, decreased PLT, and low albumin were independent risk factors for in-hospital mortality.
社区获得性肺炎（CAP）在老年人中导致高发病率和死亡率，全球每年有300万人死亡。多种合并症显著增加了风险。本研究旨在确定老年CAP患者死亡的独立危险因素，以优化个体化治疗策略。
本单中心回顾性研究在西安医学院第一附属医院进行。回顾性收集2018年12月至2023年12月期间诊断为CAP的老年患者的临床资料。采用逻辑回归分析确定院内死亡的危险因素。基于最终模型构建列线图进行风险评估。
共纳入613例符合条件的患者，其中男性占68.2%，中位年龄为78岁（四分位间距70 - 86岁）。高血压、冠心病（CHD）、中风、糖尿病、恶性肿瘤和慢性阻塞性肺疾病（COPD）的患病率分别为55.5%、39.8%、29.5%、27%、16.6%和7%。院内死亡率为48%。与幸存者相比，非幸存者年龄更大，男性比例更高，心率更快，合并症发生率更高。多因素逻辑回归分析确定年龄（比值比[OR]1.05，95%置信区间[CI][1.02 - 1.07]，P < 0.01）、体重指数（BMI）（OR 0.92，95% CI[0.86 - 0.98]，P < 0.01）、中风（OR 2.21，95%[1.43 - 3.42]，P < 0.01）、急性呼吸窘迫综合征（ARDS）（OR 4.0，95% CI[2.17 - 7.37]，P < 0.01）、急性肾损伤（AKI）（OR 2.98，95% CI[1.77 - 5.01]，P < 0.01）、恶性肿瘤（OR 2.11，95% CI[1.22 - 3.65]，P < 0.01）、白细胞（WBC）升高（OR 1.20，95%[1.14 - 1.27]，P < 0.01）、血小板（PLT）（OR 0.995，95% CI[0.993 - 0.998]，P < 0.01）和白蛋白（OR 0.93，95% CI[0.90 - 0.97]，P < 0.01）为院内死亡的独立危险因素。多变量模型的曲线下面积（AUC）为0.85（95% CI[0.81 - 0.87]，P < 0.01）。
老年CAP患者合并症患病率高，院内死亡率高。高龄、低BMI、中风、ARDS、AKI、恶性肿瘤、WBC升高、PLT降低和低白蛋白是院内死亡的独立危险因素。
