Reaching stability in community-acquired pneumonia:: The effects of the severity of disease, treatment, and the characteristics of patients
Reaching stability in community-acquired pneumonia:: The effects of the severity of disease, treatment, and the characteristics of patients
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DOI：
10.1086/426028
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发表时间：
2004-12-15
影响因子：
11.8
通讯作者：
Molinos, L
中科院分区：
文献类型：
--
作者：
Menéndez, R;Torres, A;Molinos, L
背景。社区获得性肺炎（CAP）患者感染参数消退的自然历史尚不完全清楚。本研究的目的是确定与宿主特征、肺炎严重程度和治疗相关的影响临床稳定性的因素。在一项前瞻性、多中心、观察性研究中，我们观察了西班牙15家医院收治的1424例CAP患者。主要结局变量为达到临床稳定所需的天数（定义为体温小于或等于37.2℃，心率小于或等于100次/分钟，呼吸频率小于或等于24次/分钟，收缩压大于或等于90mmhg，氧饱和度大于或等于90%或动脉氧分压大于或等于60mmhg）。结果。平均稳定时间为4天。Cox比例风险模型确定了入院后24小时内记录的6个与达到稳定所需时间相关的自变量：呼吸困难（风险比[HR]， 0.76）、精神混乱（风险比，0.66）、胸腔积液（风险比，0.67）、多叶性CAP（风险比，0.72）、高肺炎严重程度指数（风险比，0.73）和遵守西班牙CAP治疗指南（风险比，1.22）。第二个Cox模型包括并发症和对治疗的反应。该模型确定了以下10个自变量：慢性支气管炎（HR, 0.81）、呼吸困难（HR, 0.79）、精神混乱（HR, 0.61）、多叶性CAP （HR, 0.84）、疾病初始严重程度（HR, 0.73）、治疗失败（HR, 0.31）、心脏并发症（HR, 0.66）、呼吸系统并发症（HR, 0.77）、脓胸（HR, 0.57）和入住重症监护室（HR, 0.57）。在入院时，CAP的一些特征对确定需要更长时间住院以达到临床稳定的患者是有用的。遵循指南的经验性治疗与早期临床稳定有关。并发症和治疗失败延迟了临床稳定性。
Background. The natural history of the resolution of infectious parameters in patients with community-acquired pneumonia ( CAP) is not completely known. The aim of our study was to identify those factors related to host characteristics, the severity of pneumonia, and treatment that influence clinical stability.Methods. In a prospective, multicenter, observational study, we observed 1424 patients with CAP who were admitted to 15 Spanish hospitals. The main outcome variable was the number of days needed to reach clinical stability (defined as a temperature of less than or equal to37.2degreesC, a heart rate of less than or equal to 100 beats/min, a respiratory rate of less than or equal to24 breaths/min, systolic blood pressure of greater than or equal to90 mm Hg, and oxygen saturation greater than or equal to90% or arterial oxygen partial pressure of greater than or equal to60 mm Hg).Results. The median time to stability was 4 days. A Cox proportional hazard model identified 6 independent variables recorded during the first 24 h after hospital admission related to the time needed to reach stability: dyspnea (hazard ratio [HR], 0.76), confusion (HR, 0.66), pleural effusion (HR, 0.67), multilobed CAP (HR, 0.72), high pneumonia severity index (HR, 0.73), and adherence to the Spanish guidelines for treatment of CAP (HR, 1.22). A second Cox model was performed that included complications and response to treatment. This model identified the following 10 independent variables: chronic bronchitis (HR, 0.81), dyspnea (HR, 0.79), confusion (HR, 0.61), multilobed CAP (HR, 0.84), initial severity of disease (HR, 0.73), treatment failure (HR, 0.31), cardiac complications (HR, 0.66), respiratory complications (HR, 0.77), empyema (HR, 0.57), and admission to the intensive care unit (HR, 0.57).Conclusions. Some characteristics of CAP are useful at the time of hospital admission to identify patients who will need a longer hospital stay to reach clinical stability. Empirical treatment that follows guidelines is associated with earlier clinical stability. Complications and treatment failure delay clinical stability.