Riquelme R, Torres A, el-Ebiary M, Mensa J, Estruch R, Ruiz M, Angrill J, Soler N
Servei de Pneumologia i Al.lèrgia Respiratòria, Universitat de Barcelona, Spain.
Am J Respir Crit Care Med. 1997 Dec;156(6):1908-14. doi: 10.1164/ajrccm.156.6.9702005.
Community-acquired pneumonia (CAP) in the elderly has a different clinical presentation than CAP in other age groups. Confusion, alteration of functional physical capacity, and decompensation of underlying illnesses may appear as unique manifestations. Malnutrition is also an associated feature of CAP in this population. We undertook a study to assess the clinical and nutritional aspects of CAP requiring hospitalization in elderly patients (over 65 yr of age). One hundred and one patients with pneumonia, consecutively admitted to a 1,000-bed teaching hospital over an 8-mo period, were studied (age: 78 +/- 8 yr, mean +/- SD). Nutritional aspects and the mental status of patients with pneumonia were compared with those of a control population (n = 101) matched for gender, age, and date of hospitalization. The main symptoms were dyspnea (n = 71), cough (n = 67), and fever (n = 64). The association of these symptoms with CAP was observed in only 32 patients. The most common associated conditions were cardiac disease (n = 38) and chronic obstructive pulmonary disease (COPD) (n = 30). Seventy-seven (76%) episodes of pneumonia were clinically classified as typical and 24 as atypical. There was no association between the type of isolated microorganism and the clinical presentation of CAP, except for pleuritic chest pain, which was more common in pneumonia episodes caused by classical microorganisms (p = 0.02). This was confirmed by a multivariate analysis (relative risk [RR] = 11; 95% confidence interval [CI]: 1.7 to 65; p = 0.0099). The prevalence of chronic dementia was similar in the pneumonia cohort (n = 25) and control group (n = 18) (p = 0.22). However, delirium or acute confusion were significantly more frequent in the pneumonia cohort than in controls (45 versus 29 episodes; p = 0.019). Only 16 patients with pneumonia were considered to be well nourished, as compared with 47 control patients (p = 0.001). Kwashiorkor-like malnutrition was the predominant type of malnutrition (n = 65; 70%) in the pneumonia patients as compared with the control patients (n = 31; 31%) (p = 0.001). The observed mortality was 26% (n = 26). Pleuritic chest pain is the only clinical symptom that can guide an empiric therapeutic strategy in CAP (typical versus atypical pneumonia). Both delirium and malnutrition were very common clinical manifestations of CAP in our study population.
老年人社区获得性肺炎（CAP）的临床表现与其他年龄组的CAP不同。意识模糊、身体功能能力改变以及基础疾病失代偿可能表现为独特的症状。营养不良也是该人群CAP的一个相关特征。我们进行了一项研究，以评估老年患者（65岁以上）因CAP需住院治疗的临床和营养方面情况。在8个月期间，对连续入住一家拥有1000张床位教学医院的101例肺炎患者进行了研究（年龄：78±8岁，均值±标准差）。将肺炎患者的营养状况和精神状态与按性别、年龄和住院日期匹配的对照组人群（n = 101）进行比较。主要症状为呼吸困难（n = 71）、咳嗽（n = 67）和发热（n = 64）。仅在32例患者中观察到这些症状与CAP相关。最常见的合并症是心脏病（n = 38）和慢性阻塞性肺疾病（COPD）（n = 30）。77例（76%）肺炎发作在临床上被分类为典型，24例为非典型。除了胸膜炎性胸痛在由经典微生物引起的肺炎发作中更常见外（p = 0.02），分离出的微生物类型与CAP的临床表现之间无关联。多因素分析证实了这一点（相对风险[RR] = 11；95%置信区间[CI]：1.7至65；p = 0.0099）。慢性痴呆的患病率在肺炎队列（n = 25）和对照组（n = 18）中相似（p = 0.22）。然而，肺炎队列中谵妄或急性意识模糊明显比对照组更常见（45例对29例发作；p = 0.019）。与47例对照患者相比，仅16例肺炎患者被认为营养良好（p = 0.001）。与对照患者（n = 31；31%）相比，肺炎患者中夸希奥科样营养不良是主要的营养不良类型（n = 65；70%）（p = 0.001）。观察到的死亡率为26%（n = 26）。胸膜炎性胸痛是唯一能指导CAP（典型与非典型肺炎）经验性治疗策略的临床症状。在我们的研究人群中，谵妄和营养不良都是CAP非常常见的临床表现。
