Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Risk Factors for Mortality in Community-Acquired Pneumonia Patients Admitted to a Referral Hospital

지역사회획득폐렴으로 대학 병원에 입원한 성인의 사망률과 관련된 위험인자

  • Lee, Young Woo (Department of Internal Medicine, Chung Ang University College of Medicine) ;
  • Jung, Jae Woo (Department of Internal Medicine, Chung Ang University College of Medicine) ;
  • Song, Ju Han (Department of Internal Medicine, Chung Ang University College of Medicine) ;
  • Jeon, Eun Ju (Department of Internal Medicine, Chung Ang University College of Medicine) ;
  • Choi, Jae Cheol (Department of Internal Medicine, Chung Ang University College of Medicine) ;
  • Shin, Jong Wook (Department of Internal Medicine, Chung Ang University College of Medicine) ;
  • Kim, Jae Yeol (Department of Internal Medicine, Chung Ang University College of Medicine) ;
  • Park, In Won (Department of Internal Medicine, Chung Ang University College of Medicine) ;
  • Choo, Byoung Whui (Department of Internal Medicine, Chung Ang University College of Medicine)
  • 이영우 (중앙대학교 의과대학 내과학교실) ;
  • 정재우 (중앙대학교 의과대학 내과학교실) ;
  • 송주한 (중앙대학교 의과대학 내과학교실) ;
  • 전은주 (중앙대학교 의과대학 내과학교실) ;
  • 최재철 (중앙대학교 의과대학 내과학교실) ;
  • 신종욱 (중앙대학교 의과대학 내과학교실) ;
  • 김재열 (중앙대학교 의과대학 내과학교실) ;
  • 박인원 (중앙대학교 의과대학 내과학교실) ;
  • 최병휘 (중앙대학교 의과대학 내과학교실)
  • Received : 2006.08.07
  • Accepted : 2006.09.26
  • Published : 2006.10.30
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Abstract

Background: Pneumonia is the most common cause of death among infectious diseases with community-acquired pneumonia being the sixth leading cause of death in the USA. In Korea, several studies have evaluated the prognosis of community-acquired pneumonia with a limited number of patients and risk factors. This study, evaluated all the possible risk factors (including the pneumonia severity index; PSI) in for the community-acquired pneumonia patients admitted to a referral hospital. Methods: The medical records of patients admitted to the Chung-Aug University Yongsan Hospital between January 2002 and January 2005 for community-acquired pneumonia were reviewed retrospectively. The demographic data, comorbidity, radiographic findings and laboratory results which might influence the prognosis of pneumonia were analyzed. Results: Among 179 patients admitted for community-acquired pneumonia, 29 patients died (mortality 16%). The risk factors for mortality in the comorbidity category were congestive heart failure and a myocardial infarction. The laboratory data, showed that albumin, LDH, total cholesterol, HDL, PT, aPTT, hemoglobin and blood urea nitrogen (BUN) were related to the prognosis. For the pneumonia severity index, the mortality rate increased in a step-wise manner from class I through class V. Conclusions: Comorbidities such as congestive heart failure and myocardial infarction as well as the albumin, LDH, total cholesterol, HDL cholestreol, prothrombin time, activated partial thrombotin time, hemoglobin and blood urea nitrogen(BUN) are important risk factors for mortality in patients with community-acquired pneumonia. PSI is a valuable index for evaluating the prognosis of community-acquired pneumonia.

배 경: 지속적인 노력에도 지역사회폐렴에 의한 사망률은 증가하고 있으며 서구에서는 이에 대한 적절한 접근 및 예후 평가를 위해 예후 인자들을 확인하려 하였고 종합적인 접근을 위해 Pneumonia Severity Index(PSI) 등의 지표를 개발하였다. 하지만 국내에서는 단순 지표들만을 이용한 연구에 그치고 있어 PSI를 이용하여 폐렴으로 입원한 환자의 예후에 종합적인 접근을 할 수 있는지 확인하고자 하였다. 방 법: 2002년 1월부터 2005년 1월까지 지역사회폐렴으로 입원한 179명의 환자들을 대상으로 생존군/사망군 그리고 일반병실 입원환자/중환자실 입원 환자 사이를 비교하였으며, 각 군에 대해 Pneumonia Severity Index를 분석하였다. 결 과: 사망군과 생존군 사이에는 평균 수축기 혈압, 평균 이완기 혈압, 평균 맥박수, 평균 호흡수, 평균 체온, albumin, LDH, total cholesterol, HDL, PT, aPTT, hemoglobin, blood urea nitrogen(BUN)에서 유의한 차이가 있었다. (p<0.05) 일반병실과 중환자실 입원환자 사이에는 평균 맥박수, pH, $pCO_2$, $pO_2$, $SaO_2$, 혈청 총 단백질, 알부민, 혈청 총 칼슘, LDH, 총 콜레스테롤, HDL, PT, aPTT, hemoglobin, blood urea nitrogen(BUN)에서 유의한 차이가 있었다. (p<0.05) Pneumonia Severity Index의 경우 class I에서 사망률이 가장 낮고 class가 증가할수록 사망률이 증가하였으며 class V에서 사망률이 가장 높았다. 결 론: 다양한 지표들을 이용하여 지역사회폐렴으로 입원한 환자들을 평가할 수 있으나, Pneumonia Severity Index(PSI)를 이용하여 종합적인 접근을 할 수 있으며 이를 국내 환자에게 유용하게 이용할 수 있을 것으로 본다.

Keywords

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