Risk factors for the development of acute lung injury in patients with infectious pneumonia.
Risk factors for the development of acute lung injury in patients with infectious pneumonia.
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DOI：
10.1186/cc11247
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发表时间：
2012-12-12
期刊：
影响因子：
--
通讯作者：
Gajic O
中科院分区：
文献类型：
--
作者：
Kojicic M;Li G;Hanson AC;Lee KM;Thakur L;Vedre J;Ahmed A;Baddour LM;Ryu JH;Gajic O
尽管肺炎已被确定为急性肺损伤 (ALI) 的最常见危险因素，但我们对于为什么某些肺炎患者会发生 ALI 而其他患者则不会发生 ALI 的了解有限。本研究的目的是确定感染性肺炎患者发生 ALI 的频率、危险因素和结果。这是一项对 2005 年 1 月 1 日至 2007 年 12 月 31 日期间在两家 Mayo Clinic Rochester 医院住院的微生物学阳性肺炎成年患者进行的回顾性队列研究。在随后的巢式病例对照分析中，我们以 1:1 的方式评估了患有和不患有 ALI/急性呼吸窘迫综合征 (ARDS) 的患者之间院前和院内暴露的差异，这些患者与特定病原体、隔离地点、性别和最接近的年龄相匹配。该研究纳入了 596 名患者； 365 名（61.2%）为男性。中位年龄为 65（IQR，53 至 75）岁。总共有 171 名患者 (28.7%) 被诊断患有 ALI。与病毒性肺炎（55 例中的 19 例，35%）、真菌性肺炎（95 例中的 39 例，41%）和混合分离肺炎（34 例中的 14 例，41%；P = 0.002）相比，细菌性肺炎（n = 412 例中的 99 例，24%）的 ALI 发生频率较低。在调整疾病和合并症的基线严重程度后，发生 ALI 的患者医院死亡风险显着增加（ORadj 9.7；95% CI，6.0 至 15.9）。在一项巢式病例对照研究中，休克（OR，8.9；95% CI，2.8至45.9）、初始抗菌治疗不当（OR，3.2；95% CI，1.3至8.5）和输血（OR，4.8；95% CI，1.5至19.6）独立预测ALI的发展。因感染性肺炎住院的患者中 ALI 的发展因肺部病原体而异，并且与死亡率增加相关。不适当的初始抗菌治疗和输血可预测 ALI 的发展，与病原体无关。
Although pneumonia has been identified as the single most common risk factor for acute lung injury (ALI), we have a limited knowledge as to why ALI develops in some patients with pneumonia and not in others. The objective of this study was to determine frequency, risk factors, and outcome of ALI in patients with infectious pneumonia. A retrospective cohort study of adult patients with microbiologically positive pneumonia, hospitalized at two Mayo Clinic Rochester hospitals between January 1, 2005, and December 31, 2007. In a subsequent nested case-control analysis, we evaluated the differences in prehospital and intrahospital exposures between patients with and without ALI/acute respiratory distress syndrome (ARDS) matched by specific pathogen, isolation site, gender, and closest age in a 1:1 manner. The study included 596 patients; 365 (61.2%) were men. The median age was 65 (IQR, 53 to 75) years. In total, 171 patients (28.7%) were diagnosed with ALI. The occurrence of ALI was less frequent in bacterial (n = 99 of 412, 24%) compared with viral (n = 19 of 55, 35%), fungal (n = 39 of 95, 41%), and mixed isolates pneumonias (n = 14 of 34, 41%; P = 0.002). After adjusting for baseline severity of illness and comorbidities, patients in whom ALI developed had a markedly increased risk of hospital death (ORadj 9.7; 95% CI, 6.0 to 15.9). In a nested case-control study, presence of shock (OR, 8.9; 95% CI, 2.8 to 45.9), inappropriate initial antimicrobial treatment (OR, 3.2; 95% CI, 1.3 to 8.5), and transfusions (OR, 4.8; 95% CI, 1.5 to 19.6) independently predicted ALI development. The development of ALI among patients hospitalized with infectious pneumonia varied among pulmonary pathogens and was associated with increased mortality. Inappropriate initial antimicrobial treatment and transfusion predict the development of ALI independent of pathogen.
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影响因子：
19.7
作者：
Goodman, LR;Fumagalli, R;Pesenti, A
通讯作者：
Pesenti, A
影响因子：
38.9
作者：
Antonelli, Massimo;Levy, Mitchell;Torres, Antoni
通讯作者：
Torres, Antoni
影响因子：
8.8
作者：
Gong, MN;Thompson, BT;Christiani, DC
通讯作者：
Christiani, DC
影响因子：
39.2
作者：
Esteban, A;Fernández-Segoviano, P;Ríos, F
通讯作者：
Ríos, F
影响因子：
4.4
作者：
Bartlett JG
通讯作者：
Bartlett JG