Risk, Severity and Outcome of Bacterial Pneumonia in an HIV +/- Veteran Cohort

描述（由申请人提供）：本申请涉及广泛的挑战领域（04）临床研究，特定的挑战主题04-HL-104“对现有数据进行二次分析，以回答重要的临床和预防医学研究问题。“我们建议使用退伍军人老龄化队列研究（VACS）的现有数据来检查与HIV未感染（HIV-）患者相比，HIV感染（HIV+）患者细菌性肺炎发病率和严重程度的风险因素。VACS是一项正在进行的多中心前瞻性研究，纳入了2001-2002年在8个US VAMC入组的3，413例HIV+和3，413例年龄、人种/种族和中心匹配的HIV-患者。我们将使用VACS中已有的丰富数据，并在细菌性肺炎患者中添加完整的图表评论。我们提出以下目标：1.确定发生和复发细菌性肺炎的危险因素; 2.确定细菌性肺炎严重程度的危险因素; 3.根据细菌性肺炎的严重程度描述医院利用率和死亡率。我们将全面研究危险因素和护理过程与肺炎的病因、严重程度和预后之间的关系，并对潜在的混杂因素进行调整。肺炎事件将通过病历审查进行验证，并分类为偶发或复发，以及社区或医院获得性。肺炎的严重程度将通过就诊时的肺炎严重程度指数（PSI）进行描述。由于在目前的联合抗逆转录病毒治疗（CART）时代，HIV+患者的细菌性肺炎发病率仍然很高，即使在CD 4细胞计数>500的患者中，我们也试图确定可能的可改变因素，为未来的预防性研究提供基础。特别是，我们对酒精作为肺炎发病率和严重程度的风险因素感兴趣，因为酒精使用在HIV+人群中很常见;与肺炎风险增加有关;免疫功能障碍;和急性肺损伤。因此，酒精使用，即使在HIV+患者中处于低水平，也可能增加与细菌感染相关的肺损伤的易感性，并易患严重疾病。这些分析将提供对患者护理有直接影响的结果，并将为干预工作提供基础，以降低风险并改善细菌性肺炎的医疗保健和结局。 公共卫生相关性：该研究项目旨在确定艾滋病毒感染者和未感染者中影响细菌性肺炎发展和严重程度的风险因素，细菌性肺炎是世界范围内发病率和死亡率的主要来源。特别是，我们将调查酒精使用和滥用与细菌性肺炎的关系，因为酒精可能会增加肺损伤的风险。这些研究可以为患者护理提供信息，并为未来旨在预防和改善细菌性肺炎结局的研究提供基础。

DESCRIPTION (provided by applicant): This application addresses broad Challenge Area (04) Clinical Research, specific Challenge Topic 04-HL-104 "Perform secondary analyses of existing data to answer important clinical and preventive medicine research questions." We propose to use existing data from the Veterans Aging Cohort Study (VACS) to examine risk factors for incidence and severity of bacterial pneumonia in HIV infected (HIV+) compared to HIV uninfected (HIV-) patients. VACS is an ongoing multi-site prospective study of 3,413 HIV+ and 3,413 age-, race/ethnicity- and site-matched HIV- patients, enrolled 2001-2002 at 8 US VAMC. We will use the wealth of data that is already available in VACS, and add to this full chart reviews in patients with bacterial pneumonia. We propose the following aims: 1. Determine risk factors for incident and recurrent bacterial pneumonia; 2. Determine risk factors for severity of bacterial pneumonia; 3. Describe hospital utilization and mortality according to severity of bacterial pneumonia. We will comprehensively examine the relationship between risk factors and processes of care with etiology, severity, and outcomes of pneumonia adjusting for potential confounders. Pneumonia events will be validated by chart review and categorized as incident or recurrent, and as community or hospital acquired. Severity of pneumonia will be described by the pneumonia severity index (PSI) at presentation. As rates of bacterial pneumonia remain elevated among HIV+ patients in the current era of combination antiretroviral therapy (CART), even among those with CD4 cell counts >500, we seek to identify potentially modifiable factors that may provide the basis for future preventive studies. In particular, we are interested in alcohol as a risk factor for incidence and severity of pneumonia, as alcohol use is common in HIV+ populations; is associated with increased risk of pneumonia; immune dysfunction; and acute lung injury. Thus, alcohol use, even at low levels in HIV+ patients, may enhance susceptibility to lung injury related to bacterial infection and predispose to severe disease. These analyses will provide results that have an immediate impact to inform patient care, and will provide a basis for intervention work to decrease risk and improve health care and outcomes from bacterial pneumonia. PUBLIC HEALTH RELEVANCE: This research project seeks to identify risk factors in HIV infected and uninfected individuals that influence the development and severity of bacterial pneumonia, a major source of morbidity and mortality world-wide. In particular, we will investigate the relationship of alcohol use and abuse with bacterial pneumonia, as alcohol may increase the risk for lung injury. These studies can inform patient care and provide a basis for future studies aimed at preventing and improving outcomes from bacterial pneumonia.