Analysis Of Risk Factors Of Death In Elderly Inpatients With Community Acquired Pneumonia

Objective:A retrospective analysis was performed to analyze the clinical data of inpatients with community-acquired pneumonia(CAP)in the elderly,to explore the risk factors of death,and to provide scientific guidance for the diagnosis,treatment and prognosis control of this disease.Methods: This study is a case control study.The study subjects were elderly inpatients with CAP in the respiratory ward of Shaanxi Province People's Hospital between January 1,2017 and December 31,2017.Use the hospital's digital information management platform to search and screen clinical data of patients who meet the inclusion and exclusion criteria.The predictor variables were general data,basic diseases,symptoms and signs on admission,24-hour laboratory test results,24-hour imaging studies,and treatment.Outcome variables were clinical outcome(survival,death).Establish the SPSS19.0 database.The clinical data were divided into survival group and death group according to the clinical outcomes.The SPSS 19.0 statistical software was used to analyze the data of the two groups.The t-test was used for the comparison between the numerical variables;the X~2 test was used for the comparison between the categorical variables;using the logistic regression analysis model analyze the significant difference which was analyzed between the t-test and the X~2 test that get the death risk factors and death independent risk factors.The significance level ?=0.05.Results:1.A total of 591 patients whose aged?65 years old and discharge diagnosis were having "pneumonia" were included.173 cases were excluded,and finally 418 cases were included.The surviving group included 234 males(62.9%)and 138 females(37.1%),The age range was 65 to 100 years and the average age was 77.93 ±8.04 years.The death group included 25(54.3%)males and 21 female(45.7%),The age range was 65 to 94 years and the average age was 82.00± 7.04 years.2.There was no significant difference in gender,length of hospital stay,smoking history,a-lcohol abuse history,bronchial asthma,bronchiectasis,old tuberculosis,type 2 diabetes,fever,chills,cough,cough,hemoptysis,dyspnea,chest pain,dizziness,headache in heart palp-itation,body tem perature,respiratory rate,heart rate,pulmonary rales,lymphocyte count,MPV,PDW,ALT,AST,S TB,CB,K~+, Na~+,Cl~-,and ESR(p>0.05),Showed by the univariate analysis.3.age,COPD,CKD,cardiovascular disease,nervous system dsease,long-term bed rest,disturbance of consciousness,respiratory rate,hypotension,abnormal WBC count,NLR ? 11.2,lactic acid> 1.7 mmol/L,D-D >0.59 mg/L,ALB <30 g/L,urea> 8.2 mmol/L,Cr> 120?mol/L,cys C> 1.5 mg/L,CK-MB> 4.87 ng/ml,c Tn I ? 0.03 ng/ml,BNP ?76 pg/ml,PCT ? 0.09 ng/ml,FPG> 6.1 mmol/L,multiple leaf multisegment lung disease,pleural effusion,mixed infection,combination therapy with antibiotics(p<0.05)are independent risk factors of death of eldly inpatients showd by Univariate logistic regression analysis.4.Disturbance of consciousness,DD>0.59mg/L,lactic acid>1.7 mmol/L,PCT?0.09ng/ ml,cys C> 1.5mg /L,COPD,CK D,neurological diseases,mechanical ventilation,pleural effusion,urea> 8.2 mmol/L were independent risk factors for death in elderly CAP inpatients showd by Multivariate logistic regression analysis [OR,95% CI(277.624,18.510 to 4163.996)(163.981,3.417 to 7869.17)(153.440,13.449 to 1750.539)(59.65 1,2.193 ~1274.00),(56.459,4.385~731.368)(39.573,3.263~479.96 9)(22.055,1.554 ~312.924)(18.860,2.175~ 163.522)(16.794,1.366-206.501)(9.310,1.557-56.655)(6.789,1.006-45.79 3),p< 0.05].Conclusions: 1.Age,COPD,CKD,cardiovascular disease,nervous system disease,long-term bed rest,disturbance of consciousness,respiratory rate,hypotension,abnormal WBC count,NLR ? 11.2,lactic acid> 1.7 mmol/L,DD> 0.59 mg /L,ALB <30 g/L,urea> 8.2 mmol/L,Cr> 120 ?mol/L,cys C> 1.5 mg/L,CK-MB> 4.87 ng/ml,c Tn I ? 0.03 ng/ml,BNP ? 76 pg/L Ml,PCT ? 0.09 ng/ml,multiple leaf multisegment lung disease,pleural effusion,mixed infection,combined use of antibiotics are risk factors of death in elderly CAP hospitalized patients;2.disturbance of consciousness,DD> 0.59 mg/L,lactic acid >1.7 mmol/L,PCT ? 0.09 ng/ml,cys C> 1.5 mg/L,COPD,CKD,neurological diseases,mechanical ventilation,pleural effusion,urea> 8.2 mmol/L are Independent risk factors of deaths in elderly CAP hospitalized patients.