Clinical Features And Prognostic Factor Analysis Of Elderly Community-acquired Pneumonia

Objective:Community-acquired pneumonia(CAP)in the elderly has a high morbidity and mortality.To explore the risk factors of morality in the elderly may help the old patients in the diagnosis,treatment and prognosis.Methods:Collecting the basic situation (with age, sex, tobacco hobby, merger basic diseases, or whether the use of antibiotics and in bed),dmission performance (clinical symptoms, signs, laboratory examination, lung imaging manifestations) and treatment process changes (sputum cultures, the blood culture, antibiotics use change, shock, kidney failure and mechanical ventilation, ICU admission, the length of days, clinical outcome) from January 2008 to December 2009 in Anhui Provincal Hospital discharges in line with the community-acquired pneumonia cases the diagnostic criteria for research subjects,using a retrospective study analyzing elderly patients(age=65 years or above).we used PSI (Pneumonia Severity Index) and CURB-65(Confusion,Uremia, Respiratory rate, Low blood pressure,Age 65 years or greater)for assessing the severity of CAP. The Chi-squared test and logistic regression model were used for analyzing the risk factors.Results:A total of 98 patients were included.There have male 69 cases, female 29 cases which were aged 65-91 years old and averaged (75.1±6.7) years.74 cases (75.5%) in prior to admission used antibiotics; 17 cases (17.3%) completely cannot provide for oneself, who need to prolonged bed; 86 cases (87.7%) with basic diseases, including 33 patients (33.7%) of one basic diseases,30 patients merging two basic diseases,13 cases (13.3%) merging three basic diseases,10 cases (10.2%) merging more than four based diseases. Common symptoms are including cough 86 cases (87.8%), sputum 76 cases (77.6%), fever 59 cases (60.2%), consciousness obstacle in 22 patients (22.4%), chest pain 9 cases (9.2%), shivering in 11 patients (11.2%), difficulty breathing 9 cases (9.2%), gastrointestinal symptoms such as diarrhea, vomiting or decreased appetite, etc 43 cases (43.9%). The average days in hospital is 11.3±0.6 days,12 cases (12.2%) were dead.We found the following factor associated with mortality in the univariate analysis:bed confinement,the state of basic diseases,the existence of neurological disease and respiratory system diseases,alteration in mental status,albumin values<30g/L,urea nitrogen>29mg/dl,ICU admission,high PSI score,high CURB-65 score.There were three independent risk factors:conscious disturbance [OR(odds ratio)294.674,95CI%(confidence interval):4.089-21237.545],urea nitrogen>29mg/dl(O R140.424,95%CI:3.383-5829.445) and COPD(OR126.569,95%CI:3.048-5625.431).Conclusions:We conclude that clinical characteristics of CAP in the elderly are cough,expectoration,fever,but the extra-pulmonary symptoms occupy a higher percentage.The pathogenic cultivation rate is low.PSI and CURB-65 scoring system are able to assess the prognosis of CAP; There were three independent risk factors:conscious disturbance, urea nitrogen>29mg/dl and COPD.