医療・介護関連肺炎における重症度評価と予後不良因子の検討

Prognostic Factors and Estimation of Severity of Nursing-Healthcare Associated Pneumonia

要旨　医療・介護関連肺炎(NHCAP)の診断で入院した患者156名について，入院時A-DROP，I-ROADスコアおよび血液検査データと転帰を後方視的に比較し，予後予測が可能か検討するとともに予後不良因子を検討した．その結果A-DROPと死亡退院率に有意な相関があり(r＝0.99，p＜0.001)，ロジスティック回帰分析で意識障害(OR＝5.43，p＜0.001)と低アルブミン血症(OR＝5.28，p＝0.004)が予後不良因子であり，特にA-DROP 2点以下の死亡患者は入院時にすべて低アルブミン血症を呈していた．A-DROPスコアに低アルブミン血症を1点加点し患者を3群に分けたところ，こちらも予後と良好な相関関係が得られた(r＝0.99，p＜0.001)．NHCAP患者においてA-DROPによる予後予測が可能であり，A-DROP以外の評価項目として血清アルブミン値の重要性が示唆された．

　We attempted to identify the predictive factors of the severity and prognosis of nursing-and healthcare-associated pneumonia(NHCAP). We retrospectively analyzed the clinical records of 156 consecutive patients who were admitted to our hospital with NHCAP for whom A-DROP and I-ROAD scores were available.

　The A-DROP score was strongly associated with mortality in NHCAP patients(r＝0.99, p＜0.001). Mortality was significantly increased among patients with impaired consciousness(odds ratio［OR]＝5.43, p＜0.001)or hypoalbuminemia(OR＝5.28, p＝0.004). Of note, all patients with mild NHCAP(A-DROP score≦2)who died had hypoalbuminemia.

　Addition of a hypoalbuminemia score to the A-DROP score enabled the stratification of patients with NHCAP into three groups with distinct severities and prognoses(r＝0.99, p＜0.001).

　In conclusion, the A-DROP score was useful in assessing the severity of NHCAP, and hypoalbuminemia was identified as an important prognostic factor.