急诊老年重症病毒性肺炎患者临床特征与住院死亡危险因素预测分析
Clinical characteristics and risk factors predicting in-hospital mortality among elderly patients with severe viral pneumonia in the Emergency Department
蒲连美 1任建伟 2米玉红 1贺晓楠 1韩福生 1陆艳辉 1李雅敏 1祖晓天1
作者信息
- 1. 100029 首都医科大学附属北京安贞医院北京市心肺血管疾病研究所 急诊危重症中心
- 2. 100029 首都医科大学附属北京安贞医院北京市心肺血管疾病研究所 呼吸与危重症医学科
- 折叠
摘要
目的:探讨急诊科老年重症病毒性肺炎(severe viral pneumonia,SVP)患者的临床特征和住院死亡的危险因素.方法:收集2023年12月7日至31日,北京安贞医院急诊科首次接诊的老年SVP患者的病历资料,比较生存组和死亡组的临床特征、实验室检查、治疗方案和并发症.采用多因素Logistic回归探讨与住院死亡相关的危险预测因素并通过ROC曲线评估危险因素的预测效能.结果:共纳入132例患者,生存组53例,死亡组79例,中位年龄81.0(75.0,86.0)岁,住院病死率为59.8％.85.6％的患者至少合并一种基础疾病,其中高血压最常见(67.5％),其次为慢性心脏疾病(50.8％)和2型糖尿病(40.9％).多因素Logistic回归显示,就诊时床旁快速序贯性器官功能衰竭(quick sequential organ failure assessment,qSOFA)≥ 2、Ⅰ 型呼吸衰竭和 hs-CRP 升高,以及就诊 2～3d 仍存在Ⅰ型呼吸衰竭、hs-TNI和D二聚体持续增高是老年SVP患者住院死亡的危险因素.ROC曲线下面积分别为0.774和0.786.结论:qSOFA ≥ 2分、Ⅰ型呼吸衰竭、hs-CRP升高、以及hs-TNI与D二聚体持续增高可作为早期识别老年高危SVP患者的危险预测因子,值得急诊医护人员在对患者进行分级管理时加以警惕.
Abstract
Objective:To investigate the clinical characteristics and risk predictive factors associated with in-hospital mortality among elderly patients hospitalized with severe viral pneumonia(SVP)in the Emergency Department(ED).Methods:From December 7th to 31st,2023,elderly patients who had been initially diagnosed with SVP in the ED of Beijing Anzhen Hospital were included.Clinical characteristics and laboratory data,along with treatment details and complications information,were extracted from electronic medical records for comparison between survivors and non-survivors.Multivariable Logistic regression identified risk factors for in-hospital mortality,while a ROC curve evaluated performance.Results:A total of 132 patients were included,with 79 deaths during hospitalization and 53 discharges.The median age of patients was 81 years(IQR75-86)and in-hospital case fatality rate was 59.8％.Most patients(85.6％)had at least one comorbidity,primarily hypertension(67.4％),followed by chronic cardiac disease(50.8％)and diabetes(40.9％).Multiple Logistic regression analyses revealed that in-hospital mortality was independently associated with qSOFA ≥ 2,type Ⅰ respiratory failure,and elevated hs-CRP upon admission,as well as persistent type Ⅰ respiratory failure,sustained increases in hs-TNI and D-dimer on days 2 to 3 after admission.The area under the ROC curve was 0.774 and 0.786 respectively.Conclusions:Early identification of elderly viral pneumonia patients at high risk of mortality can be facilitated by considering qSOFA ≥ 2,type Ⅰrespiratory failure,elevated hs-CRP,and sustained increases in hs-TNI and D-dimer as risk predictive factors.Emergency medical staff should exercise vigilant when classifying and managing these patients.
关键词
重症病毒性肺炎/老年患者/住院死亡/临床特征/危险预测因素Key words
Severe viral pneumonia/Elderly patients/In-hospital mortality/Clinical characteristics/Risk predictive factors引用本文复制引用
出版年
2024
NETL
NSTL
万方数据