Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Factors Associated with Early Death in Patients with Community-Acquired Pneumonia

지역사회획득폐렴에서 조기 사망과 관련된 인자

  • Park, Hun-Pyo (Department of Medicine, Keimyung University School of Medicine) ;
  • Seo, Yong-Woo (Department of Medicine, Keimyung University School of Medicine) ;
  • Lee, Jeong-Eun (Department of Medicine, Keimyung University School of Medicine) ;
  • Kim, Young-Ho (Department of Medicine, Keimyung University School of Medicine) ;
  • Jang, Young-Yun (Department of Medicine, Keimyung University School of Medicine) ;
  • Park, Soon-Hyo (Department of Medicine, Keimyung University School of Medicine) ;
  • Seo, Chang-Kyun (Department of Medicine, Keimyung University School of Medicine) ;
  • Jeon, Young-June (Department of Medicine, Keimyung University School of Medicine) ;
  • Lee, Mi-Young (Department of Preventive Medicine, Keimyung University School of Medicine) ;
  • Choi, Won-Il (Department of Medicine, Keimyung University School of Medicine)
  • 박훈표 (계명대학교 동산의료원 호흡기내과) ;
  • 서용우 (계명대학교 동산의료원 호흡기내과) ;
  • 이정은 (계명대학교 동산의료원 호흡기내과) ;
  • 김영호 (계명대학교 동산의료원 호흡기내과) ;
  • 장영윤 (계명대학교 동산의료원 호흡기내과) ;
  • 박순효 (계명대학교 동산의료원 호흡기내과) ;
  • 서창균 (계명대학교 동산의료원 호흡기내과) ;
  • 전영준 (계명대학교 동산의료원 호흡기내과) ;
  • 이미영 (계명대학교 동산의료원 예방의학교실) ;
  • 최원일 (계명대학교 동산의료원 호흡기내과)
  • Received : 2005.01.26
  • Accepted : 2005.06.01
  • Published : 2005.06.30
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Abstract

Background : Early death is an important problem associated with the management of community-acquired pneumonia. However, there is little information on the risk factors associated with it. The aim of this study was to identify the factors associated with early death in community-acquired pneumonia patients. Methods : From January 1999 to July 2004, 1,487 adult patients with community-acquired pneumonia who were admitted to the pulmonary department via emergency center were examined. Early death was defined as those who died within 2 days of hospitalization. The clinical and laboratory aspects of the patients who died early (n = 30) were compared with those of an age and gender matched control population (n = 60). Results : In the early death group, respiratory rate, heart rate, and blood urea nitrogen (BUN) were significant higher (p < 0.05 for all), while the arterial pH, systolic pressure, and $PaO_2$ were significant lower (p < 0.05 for all) than the control. The independent factor significantly associated with early death was tachypnea (OR, 7.049). Conclusion : The importance of an early clinical assessment in emergency center with community-acquired pneumonia needs to be emphasized in order to recognize patients at risk of early death.

배 경 : 지역사회획득폐렴은 진단 및 치료의 연구 발전에 비해 사망률이 높은 질환이다. 입원환자에서 조기 사망률은 높지만 이와 연관된 인자에 대한 연구는 빈약하다. 이에 저자들은 기존 자료를 바탕으로 응급실에서 지역사회획득폐렴으로 방문하여 조기 사망한 환자들을 분석하여 관련인자를 파악하고자 하였다. 방 법 : 1999년 1월부터 2004년 7월까지 지역사회획득폐렴으로 응급실 방문하여 호흡기 내과로 입원한 환자 1487명중에서 방문 후 48시간 내에 사망한 환자 30명과 치유되어 퇴원한 환자 중 나이와 성별을 짝지은 60명을 대조군으로 비교분석하였다. 결 과 : 응급실 방문 당시 호흡수, 맥박수, 혈액요소질소는 조기사망군이 대조군에 비해 모두 유의하게 높았다(p < 0.05). 수축기 혈압, pH, 동맥혈산소분압은 모두 유의하게 낮았다 (p < 0.05). 다중회귀분석을 통해 빈호흡이 독립적으로 조기 사망에 영향을 미치는 인자로 밝혀졌다 (교차비 7.049). 결 론 : 지역사회획득폐렴으로 응급실 방문한 환자에서 조기 사망의 위험성이 높은 자를 인지하려는 노력이 필요하고, 빈호흡을 포함한 조기 임상양상 및 검사실소견을 주의 깊게 관찰하는 것이 중요할 것으로 사료된다.

Keywords

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