Clinical characteristics of influenza pneumonia in the elderly and relationship between D-dimer and disease severity.
- Author:
Jia LI
1
;
Yu XU
2
;
You Ya WANG
3
;
Zhan Cheng GAO
3
Author Information
1. Department of Emergency, Peking University People's Hospital, Beijing 100044, China.
2. Department of Pulmonary and Critical Care Medicine, Beijing Jishuitan Hospital, Beijing 100035, China.
3. Department of Pulmonary and Critical Care Medicine, Peking University People's Hospital, Beijing 100044, China.
- Publication Type:Journal Article
- Keywords:
Aged;
D-dimer;
Influenza, human;
Pneumonia
- MeSH:
Aged;
Aged, 80 and over;
Fibrin Fibrinogen Degradation Products;
Hospital Mortality;
Humans;
Influenza, Human/diagnosis*;
Male;
Pneumonia/diagnosis*;
Prognosis;
ROC Curve;
Retrospective Studies;
Severity of Illness Index
- From:
Journal of Peking University(Health Sciences)
2022;54(1):153-160
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE:To clarify the clinical characteristics of influenza pneumonia in the elderly patients and the relationship between D-dimer and the severity of influenza pneumonia.
METHODS:In the study, 52 hospitalized patients older than 65 years with confirmed influenza pneumonia diagnosed in Peking University People's Hospital on 5 consecutive influenza seasons from 2014 were retrospectively analyzed. General information, clinical symptoms, laboratory data, treatment methods and prognosis of the patients were collected. The relationship between D-dimer and pneumonia severity was analyzed, and receiver operating characteristic (ROC) curve was used to evaluate the predictive value of D-dimer.
RESULTS:Among the 52 patients, 31 were male (31/52, 59.6%), the average age was (77.1±7.4) years, and 19 of them (36.5%) were diagnosed with severe pneumonia. About 70% patients presenting with fever. In the severe group, the patients were more likely to complain of dyspnea than in the non-severe group (14/19, 73.7% vs. 10/33, 30.3%, P=0.004), severe pneumonia group had higher level of CURB-65 (confusion, urea, respiratory rate, blood pressure, and age>65), pneumonia severity index (PSI), C-reactive protein, urea nitrogen, lactate dehydrogenase, fasting glucose, and D-dimer (P value was 0.004, < 0.001, < 0.001, 0.003, 0.038, 0.018, and < 0.001, respectively), albumin was lower than that in the non-severe group [(35.8±5.6) g/L vs. (38.9±3.5) g/L, t=-2.348, P=0.018]. There was a significant positive correlation between the D-dimer at the first admission and PSI score (r=0.540, 95%CI: 0.302 to 0.714, P < 0.001), while a significant negative correlation with PaO2/FiO2 (r=-0.559, 95%CI: -0.726 to -0.330, P < 0.001). Area under the curve of D-dimer was 0.765 (95%CI: 0.627 to 0.872). Area under the curve of PSI was 0.843 (95%CI: 0.716 to 0.929). There was no statistically significant difference in test efficacy between the two (Z=2.360, P=0.174). D-dimer level over 1 225 μg/L had a positive predict value for influenza pneumonia in hospital death with a sensitivity of 76.92% and a specificity of 74.36%.
CONCLUSION:Influenza pneumonia in the elderly always has atypical symptoms, dyspnea is a prominent feature in severe cases, D-dimer level is associated with the severity of influenza pneumonia, and greater than 1 200 μg/L has a good predictive value for in-hospital death in the elderly.
