Taniguchi Jumpei, Yamana Hayato, Matsuo Yuichiro, Sasabuchi Yusuke, Matsui Hiroki, Kohro Takahide, Yasunaga Hideo
Department of Clinical Epidemiology and Health Economics School of Public Health, The University of Tokyo Tokyo Japan.
Data Science Center Jichi Medical University Tochigi Japan.
J Gen Fam Med. 2025 Apr 11;26(4):326-333. doi: 10.1002/jgf2.70016. eCollection 2025 Jul.
Limited evidence exists regarding the impact of baseline functional and cognitive impairments on the outcomes of patients with pneumonia.
We used medical and long-term care administrative databases in a prefecture in Japan that contained care need levels assessed using the national standardized certification system. We identified patients aged ≥65 years who were hospitalized for pneumonia between June 2014 and October 2018. The impairments were classified into four categories based on estimated total daily care time: no care needs, support levels 1-2, care needs level 1 (estimated care time of 25-49 min), care needs level 2-3 (50-89 min), and care needs level 4-5 (≥90 min). The primary outcome was the in-hospital mortality rate. Secondary outcomes were death and care needs at 6 months and 1 year after admission. We evaluated the outcomes based on care need levels and conducted multivariate analyses adjusting for potential confounders.
A total of 15,537 patients (mean age 83.9 years) were included. The in-hospital mortality rates for patients with no care needs, support levels 1-2 and care needs level 1, care needs levels 2-3, and care needs levels 4-5 were 10.5%, 15.9%, 21.1%, and 24.7%, respectively. The proportions of patients who died or experienced worsening care needs at 6 months were 43.6%, 60.4%, 60.0%, and 50.2%, respectively. Multivariable analyses demonstrated independent associations of preexisting care needs with both in-hospital mortality and long-term outcomes.
Preexisting long-term care needs are associated with short- and long-term outcomes in older inpatients with pneumonia.
关于基线功能和认知障碍对肺炎患者预后的影响，现有证据有限。
我们使用了日本一个县的医疗和长期护理管理数据库，其中包含使用国家标准化认证系统评估的护理需求水平。我们确定了2014年6月至2018年10月期间因肺炎住院的≥65岁患者。根据估计的每日总护理时间，将障碍分为四类：无需护理、支持水平1-2、护理需求水平1（估计护理时间为25-49分钟）、护理需求水平2-3（50-89分钟）和护理需求水平4-5（≥90分钟）。主要结局是住院死亡率。次要结局是入院后6个月和1年时的死亡和护理需求。我们根据护理需求水平评估结局，并进行多变量分析以调整潜在混杂因素。
共纳入15537例患者（平均年龄83.9岁）。无需护理、支持水平1-2、护理需求水平1、护理需求水平2-3和护理需求水平4-5的患者住院死亡率分别为10.5%、15.9%、21.1%和24.7%。6个月时死亡或护理需求恶化的患者比例分别为43.6%、60.4%、60.0%和50.2%。多变量分析表明，既往护理需求与住院死亡率和长期结局均独立相关。
既往长期护理需求与老年肺炎住院患者的短期和长期结局相关。
