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

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30d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30d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。

Abstract:

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.