The Related Factors Analysis For Severity And Death Of Community-acquired Pneumonia In The Elderly

Objective:In order to provide certain basis for estimating the elderly community-acquired pneumonia（CAP）condition,the clinical characteristics of patients with CAP were retrospectively analyzed,discussed influence of elderly patients with CAP related risk factors of disease severity and death.Methods:The clinical data of 495cases with CAP and the age of 18 years old or more were collected from February 2012 to November 2013 in the respiratory department,including general condition（age,sex,length of hospital stays,habits of smoking and alcohol）,clinical manifestation,auxiliary examination,complication,clinical diagnosis and treatment measures and outcomes etc.According to the clinical data,made the PSI（Pneumonia Severity Index）,CURB-65（Confusion,Urea nitrogen,Respiratory rate,Blood pressure and age≥65 years）and CRB-65（Confusion,Respiratory rate,Blood pressure and age≥65 years）grading.There are three points in our research:firstly,the 495 cases with CAP were divided into two groups according to the age of 65:elderly group（65 years old or higher）and non-elderly group（<65 years old）,the clinical characteristics of the patients were compared between the two groups;Secondly,we set PSI>90,that class IV-V,as the standard of severe pneumonia,used this as dependent variable sifting the influence factors of elderly CAP severity by multivariate logistic regression analysis;thirdly,establishing the assessment tool,the assessment ability and the comparison with other tools were analyzed by ROC（receiver-operating characteristic curve）and its AUC（area under the receiver-operating characteristic curve）.Results:Collecting datum of 495 cases,elderly group 320 cases,non-elderly group 175 cases:1.The clinical characteristics of 495patients with CAP:Some factors in the elderly group compared with non-elderly group showed significant difference（P<0.05）,including chest pain（9.1%）,hemoptysis（4.1%）,the edema of lower limbs（21.6%）,disturbance of consciousness（9.4%）,neutrophil count（65.9%）,liver functiondamage（24.1%）,renalimpairment（22.2%）,electrolyte disorder（32.8%）,low serum albumin leels（42.5%）,respiratory failure（37.8%）,heart failure（25.0%）,cardiovascular diseases（34.4%）,cerebrovascular disease（16.3%）,chronic obstructive pulmonary diseases（COPD）（54.4%）,invasive mechanical ventilation（9.4%）,empirical antibiotic treatment failure（31.9%）,antifungal drugs（13.1%）and death（7.5%）.2.The related risk factors which influenced the severity of elderly CAP and the assessment tool:Analyzing the data of 320 elderly CAP patients,severe pneumonia outcome was the dependent variable,analyzed by single-factor and multi-factor logistic regression analyses,the results shown that,male,poor appetite,cyanosis,disorder of consciousness,pleural effusion,cardiovascular disease,heart failure,blood urea nitrogen≥11mmol/L,PaO₂<60mmHg,PaCO₂>45mmHg,renal damage and empiric antibiotic therapy failed were included in elderly CAP severity model;established the assessment tool for the severity of elderly CAP,and analyzed by the ROC curve and AUC,the AUC of PSI,elderly community-acquired pneumonia severity index（ECAPSI）,CURB-65,CRB-65 were 0.944（95%CI:0.907-0.981）,0.892（95%CI:0.832-0.952）,0.788（95%CI:0.687-0.889）,0.699（95%CI:0.572-0.827）respectively.Conclusion:1.Atypical clinical manifestations,complex underlying diseases and complications,poor effect of empiric therapy and high risk of mortality in elderly patients with CAP;2.Male,poor appetite,cyanosis,disorder of consciousness,pleural effusion,heart failure,blood urea nitrogen≥11mmol/L,PaO₂<60mmHg,PaCO₂>45mmHg,renal damage and empiric antibiotic therapy failed were the independent risk factors for causing the elderly severe pneumonia;3.ECAPSI could provide certain basis for estimating the severity of elderly CAP.