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응급실에 입원한 지역사회획득 폐렴 노인환자에서 lactate와 SMART-COP조합의 예후 예측 능력

Prognosis predictability of combination between lactate and SMART-COP in elderly hospitalized patients with community-acquired pneumonia in the emergency department

대한응급의학회지 2020년 31권 2호 p.200 ~ 209
정아영 ( Jeong Ah-Young ) - Catholic University College of Medicine Yeouido St. Mary’s Hospital Department of Emergency Medicine

오상희 ( Oh Sang-Hee ) - Catholic University College of Medicine Yeouido St. Mary’s Hospital Department of Emergency Medicine
박상현 ( Park Sang-Hyun ) - Catholic University College of Medicine Yeouido St. Mary’s Hospital Department of Emergency Medicine
윤준성 ( Youn Chun-Song ) - Catholic University College of Medicine Seoul St. Mary’s Hospital Department of Emergency Medicine
박정호 ( Park Jung-Ho ) - Catholic University College of Medicine Yeouido St. Mary’s Hospital Department of Emergency Medicine
최승필 ( Choi Seung-Pill ) - Catholic University College of Medicine Eunpyeong St. Mary’s Hospital Department of Emergency Medicine
 ( Oh Jae-Hun ) - Catholic University College of Medicine Eunpyeong St. Mary’s Hospital Department of Emergency Medicine
박인아 ( Park In-A ) - Catholic University College of Medicine Yeouido St. Mary’s Hospital Department of Emergency Medicine

Abstract


Objective: Community-acquired pneumonia (CAP) in older patients is a potentially life-threatening infection with a poor prognosis. Therefore, is important to predict the mortality rate of CAP for older patients. This study examined the effects of predictive increases on CAP mortality by adding a biomarker to known CAP severity prediction tools.

Method: A retrospective analysis of information was conducted on patients older than 65 years, who were treated with CAP in five emergency departments from October 2016 to February 2017. The primary outcome was the 28-day mortality. The following were calculated for each patient: qSOFA (quick Sequential Organ Failure Assessment), A-DROP (Age, Dehydration, Respiratory failure, Orientation, blood Pressure), CURB-65 (Confusion, Urea level, Respiratory rate, Blood pressure, age≥65 years), SMART-COP (Systolic blood pressure, Multilobar infiltrates, Albumin, Respiratory rate, Tachycardia, Confusion, Oxygen and pH), NLR (neutrophil:lymphocyte ratio), PLR (platelet:lymphocyte ratio), and CAR (high-sensitivity C-reactive protein:albumin ratio). The prognostic value for the 28-day mortality was determined by multivariate logistic regression analysis.

Results: The 28-day mortality was 12.0% of 693 CAP patients. Multivariate logistic regression analysis showed that lactate (odds ratio [OR], 1.589; P<0.001) and CAR (OR, 1.208; P=0.006) were correlated with the 28-day mortality. NLR (OR, 1.00; P=0.983) and PLR (OR, 1.00; P=0.784) were not correlated. The area under curve (AUC) was significant as CAR 0.649, lactate 0.737, and SMART-COP 0.735 (P<0.001), and the AUC of lactate+SMART-COP increased significantly to 0.784 compared to SMART-COP (P=0.014).

Conclusion: A combination of lactate and SMART-COP can be used as a tool to assess the severity of older hospitalized CAP patients who visited emergency departments.

키워드

Pneumonia; Mortality; Aged; Lactates
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