Segado Soriano A, López González-Cobos C, Montés Germán I, Pinilla Llorente B, García Castaño J, Muiño Miguez A
Sección de Medicina de Urgencia, Hospital Gregorio Marañón, Madrid.
Rev Clin Esp. 1994 Apr;194(4):276-81.
The prognostic influence on mortality of parameters available in an emergency Unit is studied in patients with acquired community pneumonia (ACP) requiring hospitalization. Three hundred and thirty patients admitted consecutively from the emergency unit of a general hospital were evaluated. Radiological, analytical, clinical, and demographic data were recorded. The parameters associated with greater mortality were: age, absence of thoracic pain, obnubilation, hypotension, elevation in urea, GOT, GPT, LDH, decrease in prothrombin activity, pO2, pH, albumin, and the affectation of more than one lobe in a radiography of the thorax. Considering the parameters associated with a higher relative risk (age > 65 years, urea > 50 mg/dl, LDH > 460 U/l and prothrombin < 70%), the presence of three or four of these variables shaved a sensibility of 59 percent and a specificity of 93 percent in predicting mortality. In the multivariant analysis remained as significant: age, obnubilation, elevation in LDH, and decrease in the activity of prothrombin and pH. Appropriate knowledge of the prognostic factors in CAP allows for early determination of patients who require special attention in both diagnosis and in treatment upon hospitalization.
在因获得性社区肺炎(ACP)而需住院治疗的患者中,研究了急诊科可用参数对死亡率的预后影响。对一家综合医院急诊科连续收治的330例患者进行了评估。记录了放射学、分析学、临床和人口统计学数据。与较高死亡率相关的参数包括:年龄、无胸痛、意识模糊、低血压、尿素、谷草转氨酶(GOT)、谷丙转氨酶(GPT)、乳酸脱氢酶(LDH)升高,凝血酶原活性、动脉血氧分压(pO2)、pH值、白蛋白降低,以及胸部X光片显示多个肺叶受累。考虑到与较高相对风险相关的参数(年龄>65岁、尿素>50mg/dl、LDH>460U/l和凝血酶原<70%),这些变量中出现三个或四个在预测死亡率时敏感性为59%,特异性为93%。在多变量分析中,仍具有显著性的因素为:年龄、意识模糊、LDH升高、凝血酶原活性降低和pH值降低。对社区获得性肺炎(CAP)预后因素的适当了解有助于在住院时早期确定在诊断和治疗方面需要特别关注的患者。