The impact of benzodiazepines on occurrence of pneumonia and mortality from pneumonia: a nested case-control and survival analysis in a population-based cohort
The impact of benzodiazepines on occurrence of pneumonia and mortality from pneumonia: a nested case-control and survival analysis in a population-based cohort
复制标题
DOI：
10.1136/thoraxjnl-2012-202374
复制
发表时间：
2013-02-01
期刊：
影响因子：
10
通讯作者：
Myles, Puja R.
中科院分区：
文献类型：
--
作者：
Obiora, Eneanya;Hubbard, Richard;Myles, Puja R.
目的苯二氮卓类药物与重症患者感染发生率和败血症死亡率增加有关。在这里，我们确定了社区使用苯二氮卓类药物对肺炎发生率和死亡率的影响。方法一项巢式病例对照研究，使用29697例对照和4964例来自英国初级保健患者数据库健康改善网络的社区获得性肺炎（CAP）病例。（2001-2002），使用条件logistic回归研究了苯二氮卓类药物与肺炎发生之间的关系。然后使用考克斯回归来确定苯二氮卓类药物对4964例CAP患者死亡率的影响。结果显示：苯二氮卓类药物暴露与肺炎风险增加相关（OR 1.54，95%CI 1.42 ~ 1.67）。地西泮、劳拉西泮和替马西泮单独与CAP发病率增加相关，但利血平不相关。作为一类药物，苯二氮卓类药物与既往诊断为CAP的患者的30天（HR 1.22（95% CI 1.06 - 1.39））和长期死亡率（HR 1.32（95% CI 1.19 - 1.47））增加相关。个别地西泮，利血平，劳拉西泮和替马西泮影响长期mortality in these patients.Conclusions苯二氮卓类药物与CAP的风险增加和死亡率增加相关。这些假设生成数据表明，需要对苯二氮卓类药物的免疫安全性特征进行进一步研究。
Objectives Benzodiazepines have been associated with an increased incidence of infections, and mortality from sepsis, in the critically ill. Here, we determined the effect of community use of benzodiazepines on the occurrence of, and mortality following, pneumonia.Methods A nested case-control study using 29 697 controls and 4964 cases of community-acquired pneumonia (CAP) from The Health Improvement Network, a UK primary care patient database (2001-2002), investigated the association between benzodiazepines and pneumonia occurrence using conditional logistic regression. Cox regression was then used to determine the impact of benzodiazepines on mortality in the 4964 cases of CAP. Results are presented as adjusted OR, adjusted HR and 95% CI.Results Exposure to benzodiazepines was associated with an increased risk of pneumonia (OR 1.54, 95% CI 1.42 to 1.67). Individually diazepam, lorazepam and temazepam, but not chlordiazepoxide, were associated with an increased incidence of CAP. As a class, benzodiazepines were associated with increased 30-day (HR 1.22 (95% CI 1.06 to 1.39)) and long-term mortality (HR 1.32 (95% CI 1.19 to 1.47)) in patients with a prior diagnosis of CAP. Individually diazepam, chlordiazepoxide, lorazepam and temazepam affected long-term mortality in these patients.Conclusions Benzodiazepines were associated with an increased risk of, and mortality from, CAP. These hypothesis generating data suggest further research is required into the immune safety profile of benzodiazepines.