López González-Cobos C, Pinilla Llorente B, Segado Soriano A, González Ramallo V J, Recarte García-Andrade C, García Castaño J, Muiño Míguez A
Departamento de Urgencia, Hospital Universitario Gregorio Marañon, Madrid.
An Med Interna. 1995 Mar;12(3):107-10.
We studied the clinical characteristics and the initial supplementary test available in the emergency service, in aged patients with community-acquired pneumonia, as well as their mortality prognosis value. We assessed 190 patients attended consecutively during one year. Clinical, analytical and radiological data were registered. The parameters associated to a higher mortality were: age, absence of thoracic pain, reduction in the level of consciousness, leukocytosis, increased urea levels, aminotransferases, lactate dehydrogenase and reduction in prothrombin activity and pH. The data associated to a greater relative risk were: age above 80 years, absence of thoracic pain, prothrombin activity lower than 70% and ALT < 40 U/l. The presence of three to four of these variables had a sensitivity of 62% and a specificity of 94% in the prediction of mortality. In the multivariable analysis, the following variables remained significative: age, obnubilation and decrease of prothrombin. We stress the relevance of a high clinical suspicion, given the frequency of these cases with little symptomatology, in order to allow for an early treatment and the identification of right risk patients at the initial assessment.
我们研究了社区获得性肺炎老年患者在急诊时的临床特征和初始补充检查,以及它们对死亡率的预后价值。我们评估了一年内连续就诊的190例患者。记录了临床、分析和放射学数据。与较高死亡率相关的参数有:年龄、无胸痛、意识水平降低、白细胞增多、尿素水平升高、转氨酶、乳酸脱氢酶以及凝血酶原活性和pH值降低。与较高相对风险相关的数据有:年龄超过80岁、无胸痛、凝血酶原活性低于70%以及谷丙转氨酶<40 U/l。这些变量中出现三到四个在预测死亡率时的敏感性为62%,特异性为94%。在多变量分析中,以下变量仍然具有显著性:年龄、意识模糊和凝血酶原降低。鉴于这些症状轻微的病例很常见,我们强调高度临床怀疑的重要性,以便在初始评估时能够进行早期治疗并识别出正确的高危患者。