Clinical Features and Prognostic Factors of Lung Abscess

背景：雖然在過去的幾年對於病人之醫療照顧有明顯的進步，肺膿瘍仍然持續有相當高的死亡率。本研究旨在探討肺膿瘍臨床表現暨預後因數。方法：我們回溯性之研究分析從1997年一月至2003年十二月總計六年期間，在成功大學附設醫院診斷爲肺膿瘍並接受治療之病人的病曆記錄與放射學檔案。結果：在這段研究的時間總計有五十位罹患肺膿瘍病人。平均年齡是61歲（範圍由22到88歲）。平均住院天數爲23.6±13.9天，8天病人死亡，死亡率爲16%。肺膿瘍患者常合併之危險因數依序是吸煙(48%)與糖尿病(34%)。引起肺膿瘍細菌方面的分析Klebsiella pneumoniae是最主要的病菌(5/15, 33%)。至於預後因子之分析。到院時貧血（血色素＜12 gm/dl）的患者有較高的死亡率分別爲29.7% vs 0%(p=0.005)。死亡患者比起存活患者經治療後有較長的發燒期間分別是13.9±7.5vs. 5.6±4.4天(p=0.001)。經抗生素治療，仍然發燒超過七天是一個不好的預後因數，其死亡率分別是35%vs. 3%(p=0.05)。結論：即使是抗生素治療的進步，肺膿瘍死亡率依舊相當的高。到院時貧血與在廣效抗生素治療下持續性高燒大於七天是影響肺膿瘍患者死亡之兩全重要的危險因數。

關鍵字

肺膿瘍；臨床特徵；預後因子

並列摘要

Background and purpose: Despite the advances in the care of patients with lung abscess during the past few years, lung abscess continues to cause significant morbidity and death. In order to increase understanding of this condition, this study was designed to assess the clinical features and prognostic factors of lung abscess Methods: We retrospectively reviewed the medical records and chest radiographs of adult inpatients with lung abscess, who were treated at the National Cheng Kung University Hospital from January 1997 through December 2003. Results: A total of 50 patients with lung abscesses were evaluated during the study period; the median age was 61 years old (range, 22 to 88 years). The mean hospital stay was 23.6±13.9 days (range, 8-80 days). Eight patients died, yielding a mortality rate of 16%. The risk factors for lung abscess included smoking (48%) and diabetes mellitus (34%), followed by lung cancer (16%). Klebsiella pneumoniae was the major pathogen found in this study (5/15, 33%). Patients who died had significantly lower hemoglobin levels than those who survived (10.8±1.6 g/dl vs. 12.3±2.0 g/dl, p＜0.05). As we chose a hemoglobin level of 12 g/dL as the cut-off point, the patients with anemia on admission had a higher mortality rate than those without (8 of 27 vs. 0 of 23, p=0.005). The patients who died had a longer duration of fever after treatment began than those who survived (13.9±7.5 days vs. 5.6±4.4 days, p=0.001). Patients with fever lasting more than 7 days after the beginning of antibiotic treatment had a poor prognosis and were associated with a higher mortality rate than those with fever lasting less than 7 days (35% vs. 3%, p＜0.05). Conclusions: A high rate of morbidity and mortality is associated with lung abscess despite the advances in antibiotic treatment. Anemia and prolonged fever after the beginning of antibiotic treatment were 2 risk factors that affected the mortality rate in patients with lung abscess.

並列關鍵字

lung abscess ； clinical feature ； prognostic factor

國際替代計量

Clinical Features and Prognostic Factors of Lung Abscess

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