Disease risk and mortality prediction in intensive care patients with pneumonia. Australian and New Zealand practice in intensive care (ANZPIC II)
Disease risk and mortality prediction in intensive care patients with pneumonia. Australian and New Zealand practice in intensive care (ANZPIC II)
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DOI：
10.1177/0310057x0503300116
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发表时间：
2005-02-01
影响因子：
1.5
通讯作者：
Heller, RE
中科院分区：
文献类型：
--
作者：
Boots, RJ;Lipman, J;Heller, RE
本研究通过对澳大利亚和新西兰14个重症监护病房的前瞻性调查，调查了476例肺炎（48%的社区获得性肺炎，24%的医院获得性肺炎，28%的呼吸机相关肺炎）患者的肺炎危险因素和结局预测因素。社区获得性肺炎的死亡率随免疫抑制而增加(OR 5.32, CI 95% 1.58 ~ 17.99, P < 0。01)，实变的临床征象(OR 2.43, CI 95% 1.09-5.44, P = 0。2003)和脓毒症相关器官衰竭评估（SOFA）评分(OR 1.19, CI 95% 1.08 ~ 1.30, P < 0。001)，但如果在重症监护病房入院3天内适当更换抗生素，则改善（OR 0.42, CI 95% 0.20-0.86, P = 0.02）。对于医院获得性肺炎，免疫抑制（OR 6.98, CI 95% 1.16-42.2, P = 0.03）和非转移性癌症（OR 3.78, CI 95% 1.20-11.93, P = 0.02）是主要的死亡率预测因子。酒精中毒（OR 7.80, CI 95% 1.20-1750, P < 0.001）、高SOFA评分（OR 1.44, CI 95% 1.20-1.75, P = 0.001）和“高风险”生物的分离，包括铜绿假单胞菌、不动杆菌、窄养单胞菌和耐甲氧西林金黄色葡萄球菌（OR 4.79, CI 95% 1.43-16.03, P = 0.01），与呼吸机相关性肺炎死亡率增加相关。使用无创通气对社区获得性和医院获得性肺炎患者的死亡率具有独立保护作用（OR 0.35, CI 95% 0.18-0.68, P = 0.002）。同时进行有创和无创通气和单独进行无创通气的患者死亡率相似（分别为21%和20%，P = 0.56）。澳大利亚和新西兰icu的肺炎风险和死亡率预测因子因肺炎类型而异。酒精中毒史是呼吸机相关性肺炎死亡的主要危险因素，其重要性大于免疫抑制对医院获得性肺炎或社区获得性肺炎死亡的影响。无创通气与降低ICU死亡率相关。临床症状会恶化，而在ICU入院三天内合理化抗生素治疗可提高社区获得性肺炎患者的死亡率。
This study of ventilated patients investigated pneumonia risk factors and outcome predictors in 476 episodes of pneumonia (48% community-acquired pneumonia, 24% hospital-acquired pneumonia, 28% ventilator-associated pneumonia) using a prospective survey in 14 intensive care units within Australia and New Zealand. For community acquired pneumonia, mortality increased with immunosuppression (OR 5.32, CI 95% 1.58-17.99, P < 0. 01), clinical signs of consolidation (OR 2.43, CI 95% 1.09-5.44, P = 0. 03) and Sepsis-Related Organ Failure Assessment (SOFA) scores (OR 1.19, CI 95% 1.08-1.30, P < 0. 001) but improved if appropriate antibiotic changes were made within three days of intensive care unit admission (OR 0.42, CI 95% 0.20-0.86, P = 0.02). For hospital-acquired pneumonia, immunosuppression (OR 6.98, CI 95% 1.16-42.2, P = 0.03) and non-metastatic cancer (OR 3.78, CI 95% 1.20-11.93, P = 0.02) were the principal mortality predictors. Alcoholism (OR 7.80, CI 95% 1.20-1750, P < 0.001), high SOFA scores (OR 1.44, CI 95% 1.20-1.75, P = 0.001) and the isolation of "high risk" organisms including Pseudomonas aeruginosa, Acinetobacter spp, Stenotrophomonas spp and methicillin resistant Staphylococcus aureus (OR 4.79, CI 95% 1.43-16.03, P = 0.01), were associated with increased mortality in ventilator-associated pneumonia. The use of non-invasive ventilation was independently protective against mortality for patients with community-acquired and hospital-acquired pneumonia (OR 0.35, CI 95% 0.18-0.68, P = 0.002). Mortality was similar for patients requiting both invasive and non-invasive ventilation and non-invasive ventilation alone (21% compared with 20% respectively, P = 0.56). Pneumonia risks and mortality predictors in Australian and New Zealand ICUs vary with pneumonia type. A history of alcoholism is a major risk factor for mortality in ventilator-associated pneumonia, greater in magnitude than the mortality effect of immunosuppression in hospital-acquired pneumonia or community-acquired pneumonia. Non-invasive ventilation is associated with reduced ICU mortality. Clinical signs of consolidation worsen, while rationalising antibiotic therapy within three days of ICU admission improves mortality for community-acquired pneumonia patients.