A comparative study of community-acquired pneumonia patients admitted to the ward and the ICU
A comparative study of community-acquired pneumonia patients admitted to the ward and the ICU
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DOI：
10.1378/chest.07-1456
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发表时间：
2008-03-01
期刊：
影响因子：
9.6
通讯作者：
Anzueto, Antonio
中科院分区：
文献类型：
--
作者：
Restrepo, Marcos I.;Mortensen, Eric M.;Anzueto, Antonio
背景：关于社区获得性肺炎(CAP)住院患者的卫生保健利用情况的信息有限，这取决于护理的地点。我们的目的是比较住进ICU和住病房的CAP患者的临床特征、病因和转归。方法：对两所三级教学医院(其中一所是退伍军人事务部医院，另一所是县医院)进行回顾性队列研究。符合条件的受试者在1999年1月1日至2001年12月31日期间因CAP诊断而入院，有确诊的胸部X线片，以及出院的国际疾病分类第九版，诊断为肺炎。如果受试者被指定为“仅限舒适措施”，或者是从另一家急性护理医院转来的，或者是疗养院的患者，那么他们就被排除在研究之外。结果：共提取了730例患者的数据(ICU 145例，病房585例)。与病房患者相比，ICU患者更有可能是男性(p=0.001.0 1)，并有充血性心力衰竭(p=0.0 1)和慢性阻塞性肺疾病(p=0.0 1)。ICU患者的肺炎严重指数评分也较高(分别为112[SD，35]vs 83[SD，30]；p=0.02)。与病房患者相比，ICU患者的平均住院时间较长(分别为12天、10天和7天，P=0.07)，30天死亡率(23%比4%；P<；0.001)和90天死亡率(28%和8%；P<；0.001)也较高。与病房患者相比，ICU患者住院时间更长，死亡率更高。应设计管理策略以改善ICU患者的临床结果。
Background: Limited information is available on the health-care utilization of hospitalized patients with community-acquired pneumonia (CAP) depending on the location of care. Our aim was to compare the clinical characteristics, etiologies, and outcomes of patients with CAP who were admitted to the ICU with those admitted who were to the ward service.Methods: A retrospective cohort study, at two tertiary teaching hospitals, one of which was a Veterans Affairs hospital, and the other a county hospital. Eligible subjects had been admitted to the hospital with a diagnosis of CAP between January 1, 1999, and December 31, 2001, had A confirmatory chest radiograph, and a hospital discharge International Classification of Diseases, ninth revision, diagnosis of pneumonia. Subjects were excluded from the study if they had designated "comfort measures only" or had been transferred from another acute care hospital or were nursing home patients. Bivariate and multivariable analysis evaluated 30-day and 90-day mortality as the dependent measures.Results: Data were abstracted on 730 patients (ICU, 145 patients; wards, 585 patients). Compared to ward patients, ICU patients were more likely to be male (p = 0.001), and to have congestive heart failure (p = 0.01) and COPD (p = 0.01). ICU patients also had higher mean pneumonia severity index scores (112 [SD, 35] vs 83 [SD, 30], respectively; p = 0.02). Patients admitted to the ICU had a longer mean length of hospital stay (12 days [SD, 10 days] vs 7 days [SD, 17 days], respectively; p = 0.07), and a higher 30-day mortality rate (23% vs 4%, respectively; p < 0.001) and 90-day mortality rate (28% vs 8%, respectively; p < 0.001) compared to ward patients.Conclusions: ICU patients present with more severe disease and more comorbidities. ICU patients stay longer in the hospital and have a much higher mortality rate when compared to ward patients. Management strategies should be designed to improve clinical outcomes in ICU patients.