Long-Term Morbidity and Mortality After Hospitalization With Community-Acquired Pneumonia A Population-Based Cohort Study
Long-Term Morbidity and Mortality After Hospitalization With Community-Acquired Pneumonia A Population-Based Cohort Study
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DOI：
10.1097/md.0b013e318190f444
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发表时间：
2008-11-01
期刊：
影响因子：
1.6
通讯作者：
Marrie, Thomas J.
中科院分区：
文献类型：
--
作者：
Johnstone, Jennie;Eurich, Dean T.;Marrie, Thomas J.
人们对社区获得性肺炎（CAP）的长期后遗症知之甚少。所以。我们描述了需要住院治疗的肺炎患者的长期发病率和死亡率。我们特别假设了肺炎严重程度指数（PSI），旨在预测 30 天肺炎相关死亡率。也与长期全因死亡率相关。2000 年至 2002 年间，加拿大艾伯塔省埃德蒙顿市的 6 家医院收治了 3415 名患有 CAP 的成年人，前瞻性地将其纳入基于人群的队列。入院时。人口统计。临床。收集实验室数据并计算每位患者的 PSI。截至 2006 年的出院后结果是使用多个链接的管理数据库确定的。结果包括全因死亡率、住院情况。随访时间最长为 5.4 年，因肺炎而再次住院。有 3284 名患者 (96%) 可获得随访数据； 66% 的年龄 >= 65 岁。 53% 为男性，根据 PSI，预计 63% 的 30 天肺炎相关死亡率将超过 18%（即 PSI IV-V 级）。中位随访时间为 3-8 年。 30 天、1 年和研究结束时的死亡率分别为 12%、28% 和 53%。总体而言，82 名 (19%) 患者年龄 = 65 岁（风险比 [HR]，5.07：95% 置信区间 [CI]。4.06-6.34）。随访期间，男性患者比女性患者更容易死亡（分别为 971 例 [56%] 和 767 例 [49%]；FIR，1.20；95% CI，1.13-1.37）。初始 PSI 分类不仅预测 30 天死亡率，还预测出院后长期死亡率，PSI I-II 级患者中有 92 名 (15%) 死亡，而 PSI V 级患者有 616 名 (82%) 死亡（HR，11.80；95%，CL 4.70-14.70）。在 2950 名初次 CAP 住院幸存的患者中，72% 再次住院（中位数，随访期间入院 2 例），16% 因肺炎再次住院。 总之，肺炎住院后的长期发病率和死亡率很高，并且与初始 PSI 分级密切相关。这表明肺炎患者，特别是入院时 PSI IV 级和 V 级的患者，可能需要更多地关注预防策略和更密切的随访，因为他们发生后续不良事件的风险较高，并且卫生资源利用率也较高。
Little is known about the long-term sequelae of community-acquired pneumonia (CAP). Therefore. we describe file long-term morbidity and mortality of patients after pneumonia requiring hospitalization. We specifically hypothesized that I lie Pneumonia Severity Index (PSI), designed to predict 30-day pneumonia-related mortality. Would also be associated with longer-term all-cause mortality.Between 2000 and 2002. 3415 adults With CAP admitted to 6 hospitals in Edmonton, Alberta, Canada, were prospectively enrolled in a population-based cohort. At the time of hospital admission. demographic. clinical. and laboratory data were collected and the PSI was calculated for each patient. Postdischarge outcomes through to 2006 were ascertained using multiple linked administrative databases. Outcomes included all-cause mortality, hospital admissions. and re-hospitalization for pneumonia over a maximum Of 5.4 years of follow-up.Follow-up data were available For 3284 (96%) patients; 66% were >= 65 years of age. 53% were male, and according to the PSI fully 63% were predicted to have greater than 18%, 30-day pneumonia-related mortality (that is. PSI class IV-V). Median follow-up was 3-8 years. The 30-day, 1-year, and end of study mortality rates were 12%, 28%, and 53%,, respectively. Overall, 82 (19%) patients aged = 65 years (hazard ratio [HR], 5.07: 95% confidence interval [CI]. 4.06-6.34). Male patients were more likely to die than female Patients during follow-up (971 [56%] vs. 767 [49%,], respectively; FIR, 1.20; 95% CI, 1.13-1.37). Initial PSI classification predicted not only 30-day mortality, but also long-term postdischarge mortality, with 92 (15%) of PSI class I-II patients dying compared with 616 (82%) PSI class V patients (HR, 11.80; 95%, CL 4.70-14.70). Of 2950 patients who survived the initial CAP hospitalization, 72% were hospitalized again (median, 2 admissions over follow-up) and 16% were re-hospitalized with pneumonia.In conclusion, long-term morbidity and mortality are high following hospitalization tor pneumonia and arc strongly correlated with initial PSI class. This suggests that patients with pneumonia, especially those with PSI class IV and V at admission, might need better attention paid to preventive strategies and much closer follow-up due to their elevated risk of subsequent adverse events and increased health resource utilization.