Analysis of prognostic factors for hospitalized patients aged 95 years and over with community-acquired pneumonia / 中华老年医学杂志

ABSTRACT

Objective To investigate clinical characteristics and prognostic factors for hospitalized patients aged 95 years and older with community-acquired pneumonia(CAP).Methods A retrospective study was conducted on CAP patients aged ≥95 years hospitalized in Jiangsu Province Hospital or Jiangsu Province Hospital of TCM between January 2014 and January 2018.Clinical characteristics were collected.The shock index (SI),Charlson comorbidity index (CCI),neutrophil/lymphocyte rate (NLR)and CURB-65 score were calculated.The predictive value of the related factors was evaluated by using the Logistic regression model and the subjects' receiver operating characteristic curve (ROC).Results A total of 205 cases were enrolled in this study.The hospital mortality rate was 36.1 ％ (73/205).The heart rate,white blood cell count,mononuclear cell count,neutrophil count (N),NLR,fasting blood glucose,blood urea nitrogen(BUN) and D-dimer results revealed significant differences between the death group and the survival group(all P＜0.05).Scores of CCI and CURB-65 were higher in the death group than in the survival group[(2.90 ±1.88) vs.(1.91 ± 1.81),(2.34 ±0.69)vs.(1.76±0.69),both P＜0.05].Multivariate Logistic analysis showed that heart rate≥84.73 beat per minute(OR =2.452,95％CI1.054～5.702),NLR≥11.43(OR =5.499,95％CI2.132～14.180),BUN≥12.95 mmol/L(OR =2.546,95％CI1.025～6.319),CCI≥3(OR =4.453,95％CI1.191～10.113),CURB-65≥2 scores(OR =3.888,95％CI..1.288～11.735)and respiratory failure (OR =2.875,95 ％CI1.204～6.806)were risk factors for death in hospitalized elderly aged 95 years and older with CAP.ROC analysis showed that CCI combined with the CURB-65 score or CCI combined with the CURB-65 score plus NLR could better predict the in-hospital mortality of elderly patients than CCI or the CURB-65 score used alone.Conclusions Hospitalized patients aged≥95 with CAP are prone to multiple complications and high mortality rates.Combined application of multiple evaluation systems and indicators can improve the prognosis of outcomes for patients in this age group.