[Clinical characteristics of influenza pneumonia in the elderly and relationship between D-dimer and disease severity].

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.

• Authors: J Li, Y Xu, Y Y Wang, Z C Gao
• Journal: Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences (Beijing Da Xue Xue Bao Yi Xue Ban) Vol. 54 Issue 1 Pg. 153-160 (Feb 18 2022) ISSN: 1671-167X [Print] China
• PMID: 35165483 (Publication Type: Journal Article)

Chemical References

• Fibrin Fibrinogen Degradation Products
• fibrin fragment D

Topics

• 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