高龄社区获得性肺炎患者短期预后与衰弱状态的相关性  

Correlation of frailty status and short-term prognosis of community-acquired pneumonia in very old patients

作　　者：汤雯[1] 罗佳[1] 姜春燕[1] 赵真[1] 孙颖[1] 李虹伟[1] TANG Wen;LUO Jia;JIANG Chun-Yan;ZHAO Zhen;SUN Ying;LI Hong-Wei(Department of Geriatrics,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院老年医学科,北京100050

出　　处：《中华老年多器官疾病杂志》2020年第9期646-650,共5页Chinese Journal of Multiple Organ Diseases in the Elderly

基　　金：北京市医院管理局重点医学专业发展计划(ZYLX201838);首都医科大学附属北京友谊医院科研启动基金资助项目(yyqdkt2017-37)。

摘　　要：目的评估高龄社区获得性肺炎(CAP)患者病情严重程度及短期预后与其衰弱状态的相关性。方法选取2017年9月至2018年12月于北京友谊医院老年医学科住院的年龄≥80岁的117例CAP患者。应用衰弱筛查量表(FRAIL量表)评估患者是否存在衰弱状态,统计所有患者入院30d内的全因死亡率。采用受试者工作特征(ROC)曲线评价指标的预测价值。结果衰弱组患者体质量指数(BMI)、简易微型营养评价法(MNA-SF)评分、日常生活活动量表(ADL)评分、工具性日常生活活动量表(IADL)评分、白蛋白、血红蛋白均低于非衰弱组患者(均P<0.001),而衰弱组患者Charlson共病指数(CCI)、营养不良患病率、CURB-65评分、重症肺炎患病率均高于非衰弱组患者(均P<0.001)。6例(5.13%)患者在入院后30 d内死亡。多因素logistic回归分析结果显示仅重症肺炎是CAP患者30d死亡的独立危险因素(OR=9.76,95%CI 1.03~92.67;P=0.047)。FRAIL量表预测高龄患者发生重症肺炎的ROC曲线下面积为0.868,95%CI为0.787~0.948;最佳截断点为3.5分时,对应的灵敏度和特异度分别为85.7%和70.9%。结论在高龄CAP住院患者中,衰弱患者更易出现重症肺炎,且其短期预后往往欠佳。Objective To evaluate the correlation of frailty status with severity and short-term prognosis of community-acquired pneumonia(CAP)in elderly patients.Methods One hundred and seventeen CAP patients aged≥80 years admitted to our geriatrics department from September 2017 to December 2018 were enrolled in this study.FRAIL scale was used to assess whether the subjects were frail or not,and all-cause mortality was recorded within 30 days of admission.Receiver operating characteristic(ROC)curve was used to evaluate the predictive values of indices.Results The body mass index(BMI),short-form mini-nutritional assessment(MNA-SF)score,activities of daily living(ADL)score,instrumental activity of daily living(IADL)score,and albumin and hemoglobin levels were significantly lower(all P<0.001),but the Charlson comorbidity index(CCI),prevalence of malnutrition,the CURB-65 score and incidence of severe pneumonia were obviously higher(all P<0.001)in the frailty group than the non-frailty group.Six patients(5.13%)died within 30 days of admission.Multivariate logistic regression analysis showed that only severe pneumonia was an independent risk factor for 30-day mortality in the elderly CAP patients(OR=9.76,95%CI 1.03-92.67,P=0.047).The accuracy of FRAIL scale predicted severe pneumonia was 0.868,and 95%CI ranged from 0.787 to 0.948 as measured by the area under the ROC curve.When the cut-off point was 3.5 points,the sensitivity and specificity were 85.7%and 70.9%,respectively.Conclusion Among elderly hospitalized patients with CAP,frailty patients are more likely to develop severe pneumonia and have poor short-term prognosis.

关 键 词：老年人 社区获得性肺炎 重症肺炎 衰弱 

分 类 号：R563.[医药卫生—呼吸系统]