共病对老年社区获得性肺炎患者院内死亡风险的影响  

Impact of comorbidities on in-hospital mortality of community-acquired pneumonia in elderly patients

作　　者：郝燕婷[1] 张帆[1] 张华[2] 张福春[1] Hao Yanting;Zhang Fan;Zhang Hua;Zhang Fuchun(Department of Geriatrics,Peking University Third Hospital,Beijing 100191,China;Research Center of Clinical Epidemiology,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院老年科,北京100191 [2]北京大学第三医院临床流行病学研究中心,北京100191

出　　处：《中华老年医学杂志》2025年第3期311-316,共6页Chinese Journal of Geriatrics

摘　　要：目的分析老年共存慢病的数量以及类型[高危(high risk,HR)和风险(at risk,AR)]与年龄≥65岁的老年社区获得性肺炎(community-acquired pneumonia,CAP)患者院内死亡风险的关联。方法回顾性研究,收集北京大学第三医院2010年1月1日至2019年12月31日住院的老年CAP患者的基本信息及诊疗资料,采用二分类logistic回归分析共存慢病的数量以及类型与老年CAP患者院内死亡之间的关联。结果共纳入2466例年龄≥65岁的老年CAP患者,年龄80(74,85)岁,发生院内死亡的病例共428例(17.36%)。合并HR慢病的老年CAP患者,其院内死亡风险增加[比值比(odds ratio,OR)=1.81、95%CI:1.44~2.28、P<0.001],合并AR慢病者,院内死亡风险明显增加(OR=15.72、95%CI:7.39~33.42、P<0.001)。患者的院内死亡风险随着AR慢病数量的增加而显著上升(OR从5.46增加至44.72)。当≥3个AR慢病叠加HR慢病时,其院内死亡风险最高(OR=85.56、95%CI:19.86~368.67、P<0.001)。与老年CAP患者院内死亡关联最重要的慢病为慢性肝脏疾病,重要性系数为0.258。结论共存慢病的类型、数量以及叠加均会显著增加老年CAP患者的院内死亡风险。因此,临床工作中遇到老年CAP患者合并多种慢病时,需高度重视共病的诊治,以降低其死亡风险。ObjectiveTo analyze the association between the number and type of comorbidities—specifically high-risk(HR)and at-risk(AR)—and the risk of in-hospital mortality among elderly patients aged 65 years and older with community-acquired pneumonia(CAP).MethodsA retrospective study was conducted to gather basic information,along with diagnostic and treatment data,for elderly CAP patients hospitalized at the Third Hospital of Peking University from January 1,2010,to December 31,2019.Binary logistic regression was employed to examine the relationships between both the number and type of coexisting chronic diseases and in-hospital mortality in this patient population.ResultsThis study included a total of 2466 elderly patients aged≥65 years with CAP,of whom 428(17.36%)died during hospitalization.The presence of HR comorbidities was associated with an increased likelihood of in-hospital mortality(OR=1.81,95%CI:1.44-2.28,P<0.001).Similarly,the presence of AR comorbidities was significantly linked to higher in-hospital mortality(OR=15.72,95%CI:7.39-33.42,P<0.001).The risk of mortality escalated with the accumulation of AR comorbidities,with risk ratios ranging from 5.46 to 44.72.Notably,elderly CAP patients with 4 to 5 AR comorbidities in conjunction with HR comorbidities exhibited the highest mortality risk(OR=85.56,95%CI:19.86-368.67,P<0.001).Among the comorbidities assessed,chronic liver disease emerged as the most significant factor associated with mortality in elderly CAP patients,with an importance coefficient of 0.258.ConclusionsIn addition to specific comorbidities,the total number of combined comorbidities and the interplay between AR and HR comorbidities may significantly influence the outcomes of hospitalized CAP patients aged 65 years and older.Therefore,it is essential to carefully consider the diagnosis and management of comorbidities in elderly CAP patients to mitigate their risk of mortality.

关 键 词：社区获得性肺炎 共病 影响因素 

分 类 号：R56[医药卫生—呼吸系统]