Riquelme R, Torres A, El-Ebiary M, de la Bellacasa J P, Estruch R, Mensa J, Fernández-Solá J, Hernández C, Rodriguez-Roisin R
Servei de Pneumologia i Al.lèrgia Respiratòria, Universitat de Barcelona, Spain.
Am J Respir Crit Care Med. 1996 Nov;154(5):1450-5. doi: 10.1164/ajrccm.154.5.8912763.
To assess the risk and prognostic factors of community-acquired pneumonia occurring in the elderly (over age 65 yr) requiring hospitalization, two studies, case-control and cohort, were performed over an 8-mo period in a 1,000-bed university teaching hospital. We studied 101 patients with pneumonia (cases), age 78.5 +/- 7.9 yr (mean +/- SD). Each case was matched for sex, age (+/- 5 yr), and date of admission (+/- 2 d) with a control subject, without pneumonia during the preceding 3 yr, arriving at the emergency room. Etiologic diagnosis was obtained in 43 of 101 (42%) cases. The main microbial agents causing pneumonia were: Streptococcus pneumoniae (19 of 43, 44%), and Chlamydia pneumoniae (9 of 43, 21%). Gram-negative bacilli were uncommon (2 of 43, 5%). The multivariate analysis demonstrated that large-volume aspiration, and low serum albumin (< 30 mg/dl) were independent risk factors associated with the development of pneumonia. Crude mortality rate was 26% (26 of 101), while pneumonia-related mortality was 20% (20 of 101). The attributable mortality was 23% (odds ratio [OR]: 11.3; 95% confidence interval [CI]: 3.25 to 60.23; p < 0.0001). The multivariate analysis showed that patients had a worse prognosis if they were previously bedridden, had prior swallowing disorders, body temperature on admission was less than 37 degrees C, respiratory frequency was greater than 30/min or had three or more affected lobes on chest radiograph. Age by itself was not a significant factor related to prognosis. Among the significant risk factors, only nutritional status is probably amenable to medical intervention. The prognostic factors found in this study may help to identify, upon admission, those subjects at higher risk and who may require special observation.
为评估65岁以上老年社区获得性肺炎患者住院治疗的风险及预后因素，在一所拥有1000张床位的大学教学医院进行了为期8个月的两项研究，即病例对照研究和队列研究。我们研究了101例肺炎患者（病例组），年龄为78.5±7.9岁（均值±标准差）。每个病例均与一名对照受试者进行性别、年龄（±5岁）和入院日期（±2天）匹配，该对照受试者在过去3年中未患肺炎，且当时正在急诊室就诊。101例病例中有43例（42%）获得了病因诊断。引起肺炎的主要微生物病原体为：肺炎链球菌（43例中的19例，44%）和肺炎衣原体（43例中的9例，21%）。革兰阴性杆菌并不常见（43例中的2例，5%）。多因素分析表明，大量误吸和低血清白蛋白（<30mg/dl）是与肺炎发生相关的独立危险因素。粗死亡率为26%（101例中的26例），而肺炎相关死亡率为20%（101例中的20例）。归因死亡率为23%（比值比[OR]：11.3；95%置信区间[CI]：3.25至60.23；P<0.0001）。多因素分析显示，如果患者既往卧床、有吞咽障碍、入院时体温低于37℃、呼吸频率大于30次/分钟或胸部X线片显示有三个或更多肺叶受累，则预后较差。年龄本身并非与预后相关的显著因素。在这些显著的危险因素中，可能只有营养状况适合进行医学干预。本研究中发现的预后因素可能有助于在入院时识别那些风险较高且可能需要特殊观察的患者。
