Purpose: The study explores a clinical model based on aging-care parameters to predict the mortality of hospitalized patients aged 80-year and above with community-acquired pneumonia (CAP).
Patients and methods: In this study, four hundred and thirty-five CAP patients aged 80-years and above were enrolled in the Central Hospital of Minhang District, Shanghai during 01,01,2018– 31,12,2021. The clinical data were collected, including aging-care relevant factors (ALB, FRAIL, Barthel Index and age-adjusted Charlson Comorbidity Index) and other commonly used factors. The prognostic factors were screened by multivariable logistic regression analysis. Receiver operating characteristic (ROC) curves were used to predict the mortality risk.
Results: Univariate analysis demonstrated that several factors, including gender, platelet distribution width, NLR, ALB, CRP, pct, pre-albumin, CURB-65, low-density, lipoprotein, Barthel Index, FRAIL, leucocyte count, neutrophil count, lymphocyte count and aCCI, were associated with the prognosis of CAP. Multivariate model analyses further identified that CURB-65 (p < 0.0001, OR = 5.44, 95% CI = 3.021– 10.700), FRAIL (p < 0.0001, OR = 5.441, 95% CI = 2.611– 12.25) and aCCI (p = 0.003, OR = 1.551, 95% CI = 1.165– 2.099) were independent risk factors, whereas ALB (p = 0.005, OR = 0.871, 95% CI = 0.788– 0.957) and Barthel Index (p = 0.0007, OR = 0.958, 95% CI = 0.933– 0.981) were independent protective factors. ROC curves were plotted to further predict the in-hospital mortality and revealed that combination of three parameters (Barthel Index+ FRAI +CURB-65) showed the best performance.
Conclusion: This study showed that CURB-65, frailty and aCCI were independent risk factors influencing prognosis. In addition, ALB and Barthel Index were protective factors for in CAP patients over 80-years old. AUC was calculated and revealed that combination of three parameters (Barthel Index+ FRAI +CURB-65) showed the best performance.

Keywords: aging care, functional status, frailty, CURB65


中文翻译：

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探索老年护理参数以预测 80 岁及以上社区获得性肺炎患者的死亡率

目的：本研究探索一种基于老年护理参数的临床模型，用于预测 80 岁及以上社区获得性肺炎 (CAP) 住院患者的死亡率。
患者与方法：本研究于 2018 年 1 月 1 日至 2021 年 31 月 12 日在上海市闵行区中心医院招募了 435 名 80 岁及以上 CAP 患者。收集临床数据，包括老年护理相关因素（ALB、FRAIL、Barthel 指数和年龄调整后的 Charlson 合并症指数）和其他常用因素。采用多因素logistic回归分析筛选预后因素。受试者工作特征（ROC）曲线用于预测死亡风险。
结果：单因素分析表明，性别、血小板分布宽度、NLR、ALB、CRP、pct、前白蛋白、CURB-65、低密度、脂蛋白、Barthel 指数、FRAIL、白细胞计数、中性粒细胞计数、淋巴细胞计数和aCCI 与 CAP 的预后相关。多变量模型分析进一步确定 CURB-65 (p < 0.0001, OR = 5.44, 95% CI = 3.021–10.700), FRAIL (p < 0.0001, OR = 5.441, 95% CI = 2.611–12.25) 和 aCCI (p = 0.003, OR = 1.551, 95% CI = 1.165–2.099) 是独立的危险因素，而 ALB (p = 0.005, OR = 0.871, 95% CI = 0.788–0.957) 和 Barthel 指数 (p = 0.0007, OR = 0.958, 95% CI = 0.933–0.981）是独立的保护因素。
结论：本研究表明，CURB-65、衰弱和aCCI是影响预后的独立危险因素。此外，ALB 和 Barthel 指数是 80 岁以上 CAP 患者的保护因素。计算 AUC 并显示三个参数（Barthel 指数 + FRAI + CURB-65）的组合表现出最佳性能。

关键词：老年护理，功能状态，衰弱，CURB65