Survival Predictors in Oldest-Old (≥85 Years Old) Patients with Acute Respiratory Distress Syndrome: A Prospective Observational Cohort Study

存活預測因子於急性呼吸窘迫症候群的老老人（大於85歲）：前瞻性觀察世代研究

張克威(Ko-Wei Chang) ； 謝孟哲(Meng-Jer Hsieh) ； 林士為(Shih-Wei Lin) ； 莊立邦(Li-Pang Chuang) ； 陳濘宏(Ning-Hung Chen) ； 胡漢忠(Han-Chung Hu) ； 李立夫(Li-Fu Li) ； 王九華(Chiu-Hua Wang) ； 黃崇旂(Chung-Chi Huang) ； 高國晉(Kuo-Chin Kao)

《胸腔醫學》 33卷6期 (2018/12) Pp. 221-229

摘要

Introduction: Acute respiratory distress syndrome (ARDS) is a high-mortality condition in the intensive care unit. Older patients can require more time and attention in the hospital, especially in intensive care. In this study, we focus on the oldest-old (more than 85 years old) ARDS patients, with the aim of investigating survival predictors in this group. Patients and Methods: In this prospective observational cohort study, we focused on patients who were admitted to our hospital’s intensive care units with the diagnosis of ARDS between October 2012 and May 2015. Demographic, comorbidity, severity, lung mechanics, and laboratory data and survival outcomes were collected and analyzed. Results: A total of 463 (49%) of 945 patients with ARDS were ≥65 years old. Eighty of these elderly patients with ARDS were ≥85 years old. The overall hospital mortality rate was 60% (48/80). The hospital survivors had lower Sequential Organ Failure Assessment (SOFA) scores (7.9 vs. 9.6, p=0.021), higher platelet counts (208.7±78.2×10^3/μL vs. 141.5±80.2×10^3/ μL, p＜0.001), higher albumin levels (2.7±0.4 g/dL vs. 2.4±0.6 g/dL, p=0.016) and lower blood urea nitrogen levels (33.4±16.4 mg/dL vs. 52.8±38.5 mg/dL, p=0.003) than the non-survivors. Multivariate logistic regression analysis found that only albumin level (odds ratio, 0.20; 95% confidence interval, 0.05-0.88, p=0.003) was significantly and independently associated with hospital mortality. Conclusions: The oldest-old ARDS patients had high hospital mortality, and the most important survival predictor was serum albumin level.

關鍵字

oldest-old ； acute respiratory distress syndrome ； SOFA score ； albumin

並列摘要

背景：急性呼吸窘迫症候群在加護病房中有很高的死亡率。老年人對於醫療照護上是一項負擔，尤其在加護照護。本篇研究中，我們針對罹患急性呼吸窘迫症候群的老老人（大於85歲），研究他們的存活預測因子。方法：在這篇前瞻性觀察世代研究中，我們蒐集2012年10月至2015年5月所有入住本院加護病房，且符合急性呼吸窘迫症候群診斷的病患，分析人口學、共病症、嚴重度指標、肺部機械特性、實驗室數據和存活預後等資料。結果：945位急性呼吸窘迫症候群病患中，老年人有463位（49%）、大於85歲有80位，院內死亡率為60%（48/80）。院內存活病患較院內死亡病患有較低的相繼器官衰竭評分（7.9 vs. 9.6, p=0.021）、較高的血小板（208.7±78.2 × 10^3/μL vs. 141.5±80.2 × 10^3/μL, p＜0.001）、較高的白蛋白（2.7±0.4 g/dL vs. 2.4±0.6 g/dL, p=0.016）、和較低的血清尿素氮（33.4±16.4 mg/dL vs. 52.8±38.5 mg/dL, p=0.003）。於多因子羅吉氏迴歸分析中，只有白蛋白為有意義且獨立的院內死亡預測因子（勝算比為0.20, 95%信賴區間為0.05-0.88, p=0.003）。結論：急性呼吸窘迫症候群的老老人有很高的院內死亡率，而最重要的存活預測因子是血清中白蛋白值。

並列關鍵字

老老人 ； 急性呼吸窘迫症候群 ； 相繼器官衰竭評分 ； 白蛋白