Severe community-acquired pneumonia: Characteristics and prognostic factors in ventilated and non-ventilated patients.
Severe community-acquired pneumonia: Characteristics and prognostic factors in ventilated and non-ventilated patients.
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严重的社区获得性肺炎：通风和非通风患者的特征和预后因素。
DOI：
10.1371/journal.pone.0191721
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发表时间：
2018
期刊：
影响因子：
3.7
通讯作者：
Torres A
中科院分区：
文献类型：
--
作者：
Ferrer M;Travierso C;Cilloniz C;Gabarrus A;Ranzani OT;Polverino E;Liapikou A;Blasi F;Torres A
患有严重社区获得性肺炎（SCAP）和危及生命的急性呼吸衰竭的患者可能需要有创机械通气（IMV）。由于 IMV 的使用通常与显着的发病率和死亡率相关，因此我们评估了有创通气患者是否是旨在降低 SCAP 死亡率的干预措施的目标人群。我们前瞻性地连续招募了 12 年的 SCAP 患者。我们评估了出现肺炎时接受有创通气的患者与未接受 IMV 的患者的特征和结果，并使用倾向评分通过多变量加权逻辑回归确定了风险因素对死亡率的影响。在 3,719 名因 CAP 住院的患者中，664 名 (18%) 符合 SCAP 标准，154 名 (23%) 在出现肺炎时接受了 IMV； 198 名 (30%) 出现感染性休克。在 370 例 (56%) 病例中，仅根据存在 3 项或以上 IDSA/ATS 次要标准即可诊断出 SCAP。肺炎链球菌是两组的主要病原菌。与非插管患者相比，IMV 患者的 30 天死亡率较高（分别为 51、33% 和 94、18%，p<0·001），并且高于 APACHE-II 评分预测的死亡率（26%）。 IMV 在多变量分析中独立预测 30 天死亡率（调整优势比 3·54，95% 置信区间 1·45–8·37，p = 0·006）。其他死亡的独立预测因素包括感染性休克、严重的低氧血症和血清钾升高。有创机械通气独立预测 SCAP 患者 30 天死亡率。有创通气患者应被视为死亡率较高的不同人群，以便在未来针对旨在降低 SCAP 死亡率的新干预措施进行临床试验。
Patients with severe community-acquired pneumonia (SCAP) and life-threatening acute respiratory failure may require invasive mechanical ventilation (IMV). Since use of IMV is often associated with significant morbidity and mortality, we assessed whether patients invasively ventilated would represent a target population for interventions aimed at reducing mortality of SCAP. We prospectively recruited consecutive patients with SCAP for 12 years. We assessed the characteristics and outcomes of patients invasively ventilated at presentation of pneumonia, compared with those without IMV, and determined the influence of risks factors on mortality with a multivariate weighted logistic regression using a propensity score. Among 3,719 patients hospitalized with CAP, 664 (18%) had criteria for SCAP, and 154 (23%) received IMV at presentation of pneumonia; 198 (30%) presented with septic shock. In 370 (56%) cases SCAP was diagnosed based solely on the presence of 3 or more IDSA/ATS minor criteria. Streptococcus pneumoniae was the main pathogen in both groups. The 30-day mortality was higher in the IMV, compared to non-intubated patients (51, 33%, vs. 94, 18% respectively, p<0·001), and higher than that predicted by APACHE-II score (26%). IMV independently predicted 30-day mortality in multivariate analysis (adjusted odds-ratio 3·54, 95% confidence interval 1·45–8·37, p = 0·006). Other independent predictors of mortality were septic shock, worse hypoxemia and increased serum potassium. Invasive mechanical ventilation independently predicted 30-day mortality in patients with SCAP. Patients invasively ventilated should be considered a different population with higher mortality for future clinical trials on new interventions addressed to improve mortality of SCAP.
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影响因子：
11.8
作者：
Liapikou, Adamantia;Ferrer, Miquel;Torres, Antoni
通讯作者：
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影响因子：
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38.9
作者：
Carrillo, Andres;Gonzalez-Diaz, Gumersindo;Torres, Antoni
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