衰弱对老年重症肺炎患者临床病程及预后的影响

Influence of debilitation on clinical course and prognosis of elderly patients with severe pneumonia

摘要:

目的 探讨老年重症肺炎患者衰弱状态与病情严重程度及预后之间的关系。方法 选取2020年1月至2024年1月在成都老年康疗院呼吸科就诊的124例老年重症肺炎患者为研究对象，依据患者衰弱状态，将其分为衰弱组(n=57)和非衰弱组(n=67);根据患者28 d内生存情况，将其分为生存组(n=91)和死亡组(n=33)。比较衰弱组与非衰弱组患者的一般临床资料、实验室指标[白细胞计数(WBC)、C反应蛋白(CRP)、降钙素原(PCT)和乳酸脱氢酶(LDH)]、急性生理和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、肺炎严重指数(PSI)评分、住院时间及重症监护病房住院时间。采用单因素和多因素Cox回归分析老年重症肺炎患者28 d内死亡的独立危险因素，并利用Kaplan-Meier生存曲线和Log-rank检验评估老年重症肺炎患者衰弱状态对其预后的影响。结果 衰弱组在年龄、性别、合并慢性疾病比例、实验室指标(WBC、CRP、PCT、LDH)、APACHEⅡ评分、PSI评分、住院时间和ICU住院时间等方面均明显高于非衰弱组(P<0.05)。Kaplan-Meier生存曲线显示，衰弱组生存期低于非衰弱组(P<0.001)。多因素Cox回归分析显示，衰弱状态、年龄、合并慢性疾病、APACHEⅡ评分及PSI评分均为老年重症肺炎患者28 d内死亡的危险因素。结论 老年重症肺炎患者的衰弱状态影响其临床病程和28 d预后，且衰弱状态、年龄、合并慢性疾病、APACHEⅡ评分、PSI评分和ICU住院时间是老年重症肺炎患者28 d内死亡的独立危险因素。

Abstract:

Objective Toinvestigatetheassociationbetweenfrailtyandtheseverityofillnessandtheprognosisin elderlypatientswithseverepneumonia.Methods Atotalof124elderlypatientswithseverepneumoniatreatedinthe RespiratoryDepartmentofChengduGeriatricCareHospitalfromJanuary2020toJanuary2024wereenrolledinthisstudy. Thepatientsweredividedintoafrailgroup (n=57)andanon-frailgroup (n=67)basedontheirscoresontheClinical FrailtyScale.Accordingtothesurvivalstatuswithin28d,thepatientswerealsocategorizedintoasurvivalgroup(n=91) andadeathgroup(n=33).Thegeneralclinicaldata,laboratoryindices[whitebloodcellcount(WBC),C-reactiveprotein (CRP),procalcitonin (PCT),andlactatedehydrogenase (LDH)],Acute Physiologyand Chronic Health Evaluation (APACHE)Ⅱ score,PneumoniaSeverityIndex(PSI)score,lengthofstay(LOS)andintensivecareunit(ICU)staywere comparedbetweenthefrailandnon-frailgroups.Univariateand multivariateCoxregressionanalyseswereperformedto identifyindependentriskfactorsformortalitywithin28d.AndKaplan-MeiersurvivalcurvesandLog-ranktestswereusedto evaluatetheeffectoffrailtyonthesurvivalperiod.Results Thefrailgroupshowedsignificantlyhighervaluesthanthe non-frailgroupintermsofage,gender,theproportionofpatientswithchroniccomorbidities,laboratoryindices (WBC, CRP,PCT,LDH),APACHEⅡ score,PSIscore,LOS,andlengthofICUstay(P<0.05).Kaplan-Meiersurvivalcurves indicatedthatthefrailgrouphadashortersurvivalperiodcomparedtothenon-frailgroup (P<0.001).MultivariateCox regressionanalysisrevealedthatfrailty,age,chroniccomorbidities,APACHEⅡscore,andPSIscorewereindependentrisk factorsfor28-daymortalityinelderlypatientswithseverepneumonia.Conclusion Frailtysignificantlyaffectstheclinical courseand28-dayprognosisinelderlypatientswithseverepneumonia.Additionally,frailty,age,chroniccomorbidities, APACHEⅡ score,PSIscore,andlengthofICUstayareindependentriskfactorsfor28-daymortalityinthesepatients.