Multiple comorbidities increase the risk of death from invasive pneumococcal disease under the age of 65 years
Multiple comorbidities increase the risk of death from invasive pneumococcal disease under the age of 65 years
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DOI：
10.1016/j.jiac.2021.04.018
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发表时间：
2021-07-27
影响因子：
2.2
通讯作者：
Ubukata, Kimiko
中科院分区：
文献类型：
--
作者：
Hanada, Shigeo;Takata, Misako;Ubukata, Kimiko
前言：在65岁以下的患者中，侵袭性肺炎球菌病(IPD)死亡的危险因素尚未明确确定。我们的目的是评估宿主和细菌因素对日本65岁以下IPD患者死亡风险的影响。方法：在这项前瞻性、观察性、多中心队列研究中，纳入2010年至2017年间年龄6-的5 81例特发性肺疾病患者。我们调查了宿主和细菌因素在28天死亡率中的作用。结果：病死率从6~44岁的3.4%~6.2%上升到45~岁的15.5%~19.5%。多变量分析确定了以下死亡率的危险因素：年龄45-年龄(危险比[HR]，3.4；95%可信区间[CI]，1.6-6.8，p=0.001)，不明病灶性菌血症(HR，2.0；95%CI，1.1-3.7，p=0.024)，脑膜炎(HR，2.1；95%CI，1.1-4.0，p=0.019)，潜在的多种非免疫损害条件(HR，2.6；与恶性肿瘤相关的免疫损害(HR，2.4；95%CI，1.0~5.2，p=0.039)。肺炎链球菌血清型与不良预后无关。结论：宿主因素，包括年龄45-和潜在的多种非免疫损害条件，是影响IPD预后的重要因素。我们的研究结果将有助于日本制定有针对性的肺炎球菌疫苗接种策略。(C)2021年日本化学学会和日本传染病协会。爱思唯尔有限公司出版。保留所有权利。
Introduction: Risk factors for death from invasive pneumococcal disease (IPD) have not been clearly established in patients aged under 65 years. We aimed to evaluate contributions of host and bacterial factors to the risk of death from IPD in patients aged under 65 years in Japan. Methods: In this prospective, observational, multicenter cohort study, patients with IPD (n = 581) aged 6 -64 years were enrolled between 2010 and 2017. We investigated the role of host and bacterial factors in 28-day mortality. Results: The mortality rate increased from 3.4% to 6.2% in patients aged 6-44 years to 15.5%-19.5% in those aged 45-64 years. Multivariable analysis identified the following risk factors for mortality: age 45 -64 years (hazard ratio [HR], 3.4; 95% confidence interval [CI], 1.6-6.8, p = 0.001), bacteremia with unknown focus (HR, 2.0; 95% CI, 1.1-3.7, p = 0.024), meningitis (HR, 2.1; 95% CI, 1.1-4.0, p = 0.019), underlying multiple non-immunocompromising conditions (HR, 2.6; 95% CI, 1.1-7.4, p = 0.023), and immunocompromising conditions related to malignancy (HR, 2.4; 95% CI, 1.0-5.2, p = 0.039). Pneumococcal serotype was not associated with poor outcomes. Conclusions: Host factors, including age of 45-64 years and underlying multiple nonimmunocompromising conditions, are important for the prognosis of IPD. Our results will contribute to the development of targeted pneumococcal vaccination strategies in Japan. (c) 2021 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.