老年社区获得性肺炎严重程度的多维度量化评估进展 ^*

Advances in multidimensional quantitative evaluation of community-acquired pneumonia severity in the elderly

摘要

老年社区获得性肺炎 (CAP) 起病隐匿, 缺乏典型的急性症状, 其诊断和病情评估难度较大, 导致预后较差, 有效的老年 CAP 的严重程度评估对临床治疗至关重要。现通用的肺炎评分工具对老年 CAP 的预测效果欠佳, 探寻更有效的评估手段迫在眉睫。与衰老相关的多种因素如衰弱、营养不良、共病等都是老年 CAP 患者的危险因素, 将这些危险因素结合 CAP 评分工具形成多维度评估有助于提高老年 CAP 患者的严重程度评估的准确性。本文围绕老年 CAP 评估展开综述, 涵盖传统评估工具、整合衰弱、营养不良及共病的肺炎评分工具, 以及多维度量化评估, 并分析现有评分工具的局限性, 为多维度量化评估在老年 CAP 的早期诊断及早期干预的应用提供依据。

Abstract

Community-acquired pneumonia (CAP) in the elderly presents with a gradual start and absence of typical acute symptoms, complicating identification and evaluation, which results in unfavorable prognoses. Accurate severity evaluation of geriatric CAP is essential for clinical therapy. Traditional pneumonia scoring systems have inadequate prediction efficacy for geriatric CAP, necessitating the urgent investigation of more effective evaluation approaches. Multiple aging-related variables, including frailty, malnutrition, and comorbidities, are risk factors for older persons with CAP. Incorporating these risk factors with CAP scoring techniques to create a multidimensional assessment can enhance the precision of severity assessments in elderly CAP patients. This review paper examines the evaluation of geriatric CAP, including conventional assessment instruments, pneumonia scoring systems that incorporate frailty, malnutrition, and comorbidities, along with recent advancements in comprehensive quantitative evaluation. It also examines the shortcomings of current scoring instruments, establishing a foundation for the utilization of multidimensional quantitative evaluation in the early diagnosis and intervention of geriatric CAP.

关键词

老年 / 社区获得性肺炎 / 严重程度 / 多维度评估

Key words

Elderly / Community-acquired pneumonia / Severity / Multidimensional assessment

参考文献

[1] Wang Y, Huang X, Luo G, et al. The aging lung: microenvironment, mechanisms, and diseases[J]. Front Immunol, 2024, 15: 1383503.

[2] Salminen A, Kaarniranta K, Kauppinen A . Age—related changes in AMPK activation: role for AMPK phosphatases and inhibitory phosphorylation by upstream signaling pathways[J]. Ageing Res Rev, 2016, 28: 15-26.

[3] van Vught L A, Endeman H, Meijvis S C, et al. The effect of age on the systemic inflammatory response in patients with community—acquired pneumonia[J]. Clin Microbiol Infect, 2014, 20(11): 1183-1188.

[4] Jabeen F, Mishra A, Mateen S, et al. Pneumonia in geriatric patients and prediction of mortality based on the pneumonia severity index (PSI), CURB—65, frailty index (FI), and FI—Lab21 scores[J]. Cureus, 2024, 16(6): e61719.

[5] Baek M S, Park S, Choi J H, et al. Mortality and prognostic prediction in very elderly patients with severe pneumonia[J]. J Intensive Care Med, 2020, 35(12): 1405-1410.

[6] Ochoa Gondar O, Vila Córcoles A, Rodriguez Blanco T, et al. Ability of the modified CRB75 severity scale in assessing elderly patients with community acquired pneumonia[J]. Aten Primaria, 2013, 45(4): 208-215.

[7] Putot A, Tetu J, Perrin S, et al. A new prognosis score to predict mortality after acute pneumonia in very elderly patients[J]. J Am Med Dir Assoc, 2016, 17(12): 1123-1128.

[8] Song Y, Wang X, Lang K, et al. Development and validation of a nomogram for predicting 28—day mortality on admission in elderly patients with severe community—acquired pneumonia[J]. J Inflamm Res, 2022, 15: 4149-4158.

[9] Wei C, Wang X, He D, et al. Clinical profile analysis and nomogram for predicting in—hospital mortality among elderly severe community—acquired pneumonia patients: a retrospective cohort study[J]. BMC Pulm Med, 2024, 24(1): 38.

[10] Huang S, Wang Y, Chen L, et al. Use of a frailty index based upon routine laboratory data to predict complication and mortality in older community—acquired pneumonia patients[J]. Arch Gerontol Geriatr, 2022, 101: 104692.

[11] 巩应军, 陈阳, 汪志平, 等 . 老年人生活状况与衰弱相关性的横断面研究[J]. 国际老年医学杂志, 2024, 45(3): 261-267.

[12] Gong Y J , Chen Y , Wang Z P , et al. A cross—sectional study on the correlation between living conditions and frailty in the elderly[J]. Int J Geriatr, 2024, 45(3): 261-267.

[13] Yang Y, Zhong Y . Impact of frailty on pneumonia outcomes in older patients: a systematic review and meta—analysis[J]. Eur Geriatr Med, 2024, 15(4): 881-891.

[14] Rosario B H, Quah J L, Chang T Y, et al. Validation of the Hospital Frailty Risk Score in older adults hospitalized with community—acquired pneumonia[J]. Geriatr Gerontol Int, 2024, 24(Suppl 1): 135-141.

[15] Park C M, Kim W, Lee E S, et al. Comparison of frailty index to pneumonia severity measures in older patients with pneumonia[J]. J Am Med Dir Assoc, 2022, 23(1): 165-169.

[16] Zan Y M, Zheng T P, Wang Y, et al. Combining a frailty index based on laboratory data and pneumonia severity assessments to predict in—hospital outcomes in older adults with community—acquired pneumonia[J]. J Nutr Health Aging, 2023, 27(4): 270-276.

[17] Clotet—Vidal S, Saez Prieto M E, Duch Llorach P, et al. Malnutrition, functional decline, and institutionalization in older adults after hospital discharge following community—acquired pneumonia[J]. Nutrients, 2023, 16(1): 11.

[18] Liao J, Hong J, Miao L, et al. A retrospective analysis of mental well—being, nutritional status, and comorbidity burden in elderly patients with community—acquired pneumonia[J]. BMC Public Health, 2025, 25(1): 667.

[19] Wang G, Wang N, Liu T, et al. Association between prognostic nutritional index and mortality risk in patients with community—acquired pneumonia: a retrospective study[J]. BMC Pulm Med, 2024, 24(1): 555.

[20] Ferreira—Coimbra J, Sarda C, Rello J . Burden of community—acquired pneumonia and unmet clinical needs[J]. Adv Ther, 2020, 37(4): 1302-1318.

[21] Dwivedi J, Wal P, Dash B, et al. Diabetic pneumopathy—a novel diabetes—associated complication: pathophysiology, the underlying mechanism and combination medication[J]. Endocr Metab Immune Disord Drug Targets, 2024, 24(9): 1027-1052.

[22] Huang L, Weng B, Gu X, et al. Performance of various pneumonia severity models for predicting adverse outcomes in elderly inpatients with community—acquired pneumonia[J]. Clin Microbiol Infect, 2024, 30(11): 1426-1432.

[23] Lv C, Pan T, Shi W, et al. Author correction: establishment of risk model for elderly CAP at different age stages: a single—center retrospective observational study[J]. Sci Rep, 2023, 13: 13787.

[24] Nguyen M T N, Saito N, Wagatsuma Y . The effect of comorbidities for the prognosis of community—acquired pneumonia: an epidemiologic study using a hospital surveillance in Japan[J]. BMC Res Notes, 2019, 12(1): 817.

[25] Pilotto A, Ferrucci L, Franceschi M, et al. Development and validation of a multidimensional prognostic index for one—year mortality from comprehensive geriatric assessment in hospitalized older patients[J]. Rejuvenation Res, 2008, 11(1): 151-161.

[26] Pilotto A, Dini S, Daragjati J, et al. Combined use of the multidimensional prognostic index (MPI) and procalcitonin serum levels in predicting 1—month mortality risk in older patients hospitalized with community—acquired pneumonia (CAP): a prospective study[J]. Aging Clin Exp Res, 2018, 30(2): 193-197.

[27] Pilotto A, Dini S, Veronese N, et al. Multidimensional Prognostic Index and pro—adrenomedullin plasma levels as mortality risk predictors in older patients hospitalized with community—acquired pneumonia: a prospective study[J]. Panminerva Med, 2018, 60(3): 80-85.

[28] Seminerio E, Morganti W, Barbagelata M, et al. Technological monitoring of motor parameters to assess multidimensional frailty of older people in the PRO—HOME project[J]. Sci Rep, 2024, 14(1): 30232.

[29] Li D, Jiang H, Sun Y, et al. The relationship between comprehensive geriatric assessment on the pneumonia prognosis of older adults: a cross—sectional study[J]. BMC Pulm Med, 2024, 24(1): 276.

[30] Hosoda T, Hamada S . Functional decline in hospitalized older patients with coronavirus disease 2019: a retrospective cohort study[J]. BMC Geriatr, 2021, 21(1): 638.

[31] Graf C E, Zekry D, Giannelli S, et al. Efficiency and applicability of comprehensive geriatric assessment in the emergency department: a systematic review[J]. Aging Clin Exp Res, 2011, 23(4): 244-254.

基金资助

^*国家老年疾病临床医学研究中心 (解放军总医院) 西部边远地区扶持项目(NCRCG-PLAGH-20230013)