요양원 혹은 요양병원에서 일개 응급의료센터로 내원한 고령 폐렴 환자들의 30일 사망률과 관련된 위험인자
Predictor of 30-day mortality in elderly patients with nursing-home acquired pneumonia at the emergency department
정주환, 오상희, 표창해, 박상현, 박현경, 박근홍, 김한범, 함은미, 이유성, 박진형,
소속 상세정보
정주환 ( Jung Ju-Hwan )
Seoul Medical Center Department of Emergency Medicine
오상희 ( Oh Sang-Hee )
Catholic University College of Medicine Yeouido St. Mary’s Hospital Department of Emergency Medicine
표창해 ( Pyo Chang-Hae )
Seoul Medical Center Department of Emergency Medicine
박상현 ( Park Sang-Hyun )
Catholic University College of Medicine Yeouido St. Mary’s Hospital Department of Emergency Medicine
박현경 ( Park Hyun-Kyung )
Seoul Medical Center Department of Emergency Medicine
박근홍 ( Park Keun-Hong )
Seoul Medical Center Department of Emergency Medicine
김한범 ( Kim Hahn-Bom )
Seoul Medical Center Department of Emergency Medicine
함은미 ( Ham Eun-Mi )
Seoul Medical Center Department of Emergency Medicine
이유성 ( Lee Yu-Sung )
Seoul Medical Center Department of Emergency Medicine
박진형 ( Park Jin-Hyung )
Seoul Medical Center Department of Emergency Medicine
KMID : 0385920200310030305
Abstract
Objective: This study evaluated the usefulness, as a risk factor of 30-day mortality, in patients residing in nursing-homes (NHs) or long-term care facilities with the diagnosis of pneumonia.
Method: We conducted a retrospective study in a public hospital between January 2017 and December 2017. The subjects included elderly patients residing in NHs and diagnosed with pneumonia in the emergency room. Data on age, gender, comorbidities, laboratory findings, pneumonia severity index score (PSI), and CURB-65 (Confusion, Urea, Respiratory rate, Blood pressure, and Age 65 or older) were entered into an electronic database.
Results: A total of 439 patients were enrolled during the study period. The mean age was 82.1±8.0 years; 195 (44.4%) were men, and 30-day mortality was 21.8%. On multivariate Cox proportional hazard analysis, cerebrovascular accidents (hazard ratio [HR], 0.53; 95% confidence interval [CI], 0.33-0.87; P=0.012), chronic renal disease (HR, 2.28; 95% CI, 1.11-4.67; P=0.024), malignancy (HR, 1.69; 95% CI, 1.04-2.76; P=0.034), lactate (HR, 1.02; 95% CI, 1.01-1.03; P<0.001), albumin (HR, 0.52; 95% CI, 0.36-0.73; P<0.001), and red cell distribution width (RDW; HR, 1.11; 95% CI, 1.03- 1.19; P=0.007) were independently associated with 30-day mortality. Areas under the curve of PSI, RDW, albumin, lactate, and PSI+RDW+albumin+lactate were 0.690 (95% CI, 0.629-0.751), 0.721 (95% CI, 0.666-0.775), 0.668 (95% CI, 0.607-0.728), 0.661 (95% CI, 0.597-0.726), and 0.801 (95% CI, 0.750-0.852), respectively.
Conclusion: RDW, albumin, lactate and especially the combination of PSI and these factors appear to be major determinants of 30-day mortality in NH residents with pneumonia.
키워드
Pneumonia; Aged; Nursing-home; Mortality
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