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J Korean Soc Emerg Med > Volume 31(3); 2020 > Article
Journal of The Korean Society of Emergency Medicine 2020;31(3): 305-314.
요양원 혹은 요양병원에서 일개 응급의료센터로 내원한 고령 폐렴 환자들의 30일 사망률과 관련된 위험인자
정주환1 , 오상희2 , 표창해1 , 박상현2 , 박현경1 , 박근홍1 , 김한범1 , 함은미1 , 이우성1 , 박진형1
1서울의료원 응급의학과
2가톨릭대학교 여의도성모병원 응급의학과
Predictor of 30-day mortality in elderly patients with nursing-home acquired pneumonia at the emergency department
Juhwan Jung1 , Sanghee Oh2 , Chang Hae Pyo1 , Sanghyun Park2 , Hyun Kyung Park1 , Keunhong Park1 , Hahnbom Kim1 , Eun Mi Ham1 , Yusung Lee1 , Jinhyung Park1
1Department of Emergency Medicine, Seoul Medical Center, Seoul, Korea
2Department of Emergency Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
Correspondence  Sanghee Oh ,Tel: 02-1661-7575, Fax: 02-3779-2099, Email: osh0532@hanmail.net,
Received: July 14, 2019; Revised: August 26, 2019   Accepted: October 2, 2019.  Published online: June 25, 2020.
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.
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.
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.
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.
Key words: Pneumonia; Aged; Nursing-home; Mortality
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