Prognostic factors associated with mortality and major in-hospital complications in patients with bacteremic pneumococcal pneumonia: Population-based study.
Prognostic factors associated with mortality and major in-hospital complications in patients with bacteremic pneumococcal pneumonia: Population-based study.
复制标题
DOI：
10.1097/md.0000000000005179
复制
发表时间：
2016-11
期刊：
影响因子：
1.6
通讯作者：
Eurich DT
中科院分区：
文献类型：
--
作者：
Beatty JA;Majumdar SR;Tyrrell GJ;Marrie TJ;Eurich DT
补充数字内容可在文本菌血症性肺炎球菌肺炎（BPP）造成相当大的死亡率和发病率。我们的目的是确定与BPP死亡率和主要住院并发症相关的预后因素。在2000年至2010年期间，在加拿大北方阿尔伯塔建立了一项前瞻性、基于人群的临床登记研究，纳入了1636例BPP住院成人患者（≥18岁）。死亡率和主要住院并发症的预后因素（例如，心脏事件、机械通气、吸入）使用多变量逻辑回归进行评估。平均年龄为54岁（标准差为18），57%为男性，59%具有高病死率（CFR）血清型。总体而言，14%（226/1636）的患者死亡，22%（315/1410）的幸存者发生至少1例并发症。死亡率的独立预后因素是年龄（调整的比值比[aOR]，1.5/10年; 95%置信区间[CI]，1.3-1.7），疗养院居住（aOR，3.7; 95% CI 1.8-7.4），社区居住性痴呆（aOR 3.7; 95% CI，1.6-8.6），酗酒（aOR，2.2; 95% CI，1.4-3.4），抑酸药物（aOR，1.5; 95% CI，1.0-2.3），指南不一致抗生素（aOR，3.4; 95%CI，2.4-4.8）、多叶肺炎（aOR，2.6; 95%CI，1.8-3.6）和高CFR血清型（aOR，1.8; 95%CI，1.2-2.8）。对于主要的住院并发症，观察到类似的预后因素。肺炎球菌疫苗接种与院内死亡率降低相关（aOR，0.2; 95%CI，0.05-0.9），但与严重并发症无关（P = 0.2）。 老年和体弱的患者，以及那些滥用酒精或服用抑酸药物的患者，与高CFR血清型的患者一样，BPP相关死亡率和并发症的风险增加。除了确定那些处于最高风险的人之外，我们的研究结果还证明了指南一致的抗生素和肺炎球菌疫苗接种在BPP患者中的重要性。
Supplemental Digital Content is available in the text Bacteremic pneumococcal pneumonia (BPP) causes considerable mortality and morbidity. We aimed to identify prognostic factors associated with mortality and major in-hospital complications in BPP. A prospective, population-based clinical registry of 1636 hospitalized adult patients (≥18 years) with BPP was established between 2000 and 2010 in Northern Alberta, Canada. Prognostic factors for mortality and major in-hospital complications (e.g., cardiac events, mechanical ventilation, aspiration) were evaluated using multivariable logistic regression. Average age was 54 (standard deviation 18) years, 57% males, and 59% had high case-fatality rate (CFR) serotypes. Overall, 14% (226/1636) of patients died and 22% (315/1410) of survivors developed at least 1 complication. Independent prognostic factors for mortality were age (adjusted odds ratio [aOR], 1.5 per decade; 95% confidence interval [CI], 1.3–1.7), nursing home residence (aOR, 3.7; 95% CI 1.8–7.4), community-dwelling dementia (aOR 3.7; 95% CI, 1.6–8.6), alcohol abuse (aOR, 2.2; 95% CI, 1.4–3.4), acid-suppressing drugs (aOR, 1.5; 95% CI, 1.0–2.3), guideline-discordant antibiotics (aOR, 3.4; 95% CI, 2.4–4.8), multilobe pneumonia (aOR, 2.6; 95% CI, 1.8–3.6), and high CFR serotypes (aOR, 1.8; 95% CI, 1.2–2.8). Similar prognostic factors were observed for major in-hospital complications. Pneumococcal vaccination was associated with reduced in-hospital mortality (aOR, 0.2; 95% CI, 0.05–0.9) but not major complications (P = 0.2). Older and frailer patients, and those who abuse alcohol or take acid-suppressing drugs, are at increased risk of BPP-related mortality and complications, as are those with high CFR serotypes. Beyond identifying those at highest risk, our findings demonstrate the importance of guideline-concordant antibiotics and pneumococcal vaccination in those with BPP.