Brancati F L, Chow J W, Wagener M M, Vacarello S J, Yu V L
Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland.
Lancet. 1993 Jul 3;342(8862):30-3. doi: 10.1016/0140-6736(93)91887-r.
Is pneumonia "the old man's friend"--a terminal event for patients who will otherwise die soon of underlying chronic disease? If so, chronological age might influence treatment policy. We investigated the predictors of 2-year mortality after patients' admission to hospital for community-acquired pneumonia, and focused on the predictive value of age. In a prospective cohort study 141 consecutive patients were admitted to hospital with community-acquired pneumonia. Clinical, laboratory, and sociodemographic data were collected on admission. Comorbidity was categorised as mild, moderate, or severe by a physician based on the patient's medical history. Survival was assessed at 24 months after discharge. 22 (16%) patients died in hospital. Of the remaining 119, 38 (32%) died over the next 24 months. In a Cox model, 2-year mortality was independently related to severe comorbidity (relative risk [RR] = 9.4) or moderate comorbidity (RR = 3.1), and to haematocrit less than 35% (RR = 2.9) (all p < or = to 0.005). However, compared with patients aged 18-44 years, patients aged 45-64 (RR = 0.84), 65-74 (RR = 1.28), and 75-92 (RR = 1.99) were not significantly more likely to die during the 24 months after discharge (all p > or = to 0.2). Old age should not be a sole criterion for withholding aggressive treatment of community-acquired pneumonia.
肺炎是“老人的朋友”——对于那些否则很快就会死于潜在慢性疾病的患者来说，是一种终末期事件吗？如果是这样，实际年龄可能会影响治疗策略。我们调查了社区获得性肺炎患者入院后2年死亡率的预测因素，并重点关注年龄的预测价值。在一项前瞻性队列研究中，141例连续的社区获得性肺炎患者入院。入院时收集临床、实验室和社会人口学数据。医生根据患者病史将合并症分为轻度、中度或重度。出院后24个月评估生存情况。22例（16%）患者在医院死亡。在其余119例中，38例（32%）在接下来的24个月内死亡。在Cox模型中,2年死亡率与严重合并症（相对危险度[RR]=9.4）或中度合并症（RR=3.1）以及血细胞比容低于35%（RR=2.9）独立相关（所有p≤0.005）。然而,与18-44岁的患者相比，45-64岁（RR=0.84）、65-74岁（RR=1.28）和75-92岁（RR=1.99）的患者在出院后24个月内死亡的可能性并没有显著增加（所有p≥0.2）。高龄不应作为拒绝积极治疗社区获得性肺炎的唯一标准。
