Kalin M, Ortqvist A, Almela M, Aufwerber E, Dwyer R, Henriques B, Jorup C, Julander I, Marrie T J, Mufson M A, Riquelme R, Thalme A, Torres A, Woodhead M A
Department of Medicine, Section of Infectious Diseases, Karolinska Hospital, 171 76 Stockholm, Sweden.
J Infect Dis. 2000 Sep;182(3):840-7. doi: 10.1086/315760. Epub 2000 Aug 17.
To define the influence of prognostic factors in patients with community-acquired pneumococcal bacteremia, a 2-year prospective study was performed in 5 centers in Canada, the United States, the United Kingdom, Spain, and Sweden. By multivariate analysis, the independent predictors of death among the 460 patients were age >65 years (odds ratio [OR], 2.2), living in a nursing home (OR, 2.8), presence of chronic pulmonary disease (OR, 2.5), high acute physiology score (OR for scores 9-14, 7.6; for scores 15-17, 22; and for scores >17, 41), and need for mechanical ventilation (OR, 4.4). Of patients with meningitis, 26% died. Of patients with pneumonia without meningitis, 19% of those with >/=2 lobes and 7% of those with only 1 lobe involved (P=.0016) died. The case-fatality rate differed significantly among the centers: 20% in the United States and Spain, 13% in the United Kingdom, 8% in Sweden, and 6% in Canada. Differences of disease severity and of frequencies and impact of underlying chronic conditions were factors of probable importance for different outcomes.
为明确社区获得性肺炎球菌菌血症患者预后因素的影响，在加拿大、美国、英国、西班牙和瑞典的5个中心开展了一项为期2年的前瞻性研究。经多因素分析，460例患者中死亡的独立预测因素为年龄>65岁（比值比[OR]，2.2）、居住在养老院（OR，2.8）、存在慢性肺病（OR，2.5）、急性生理学评分高（评分9 - 14分的OR为7.6；15 - 17分的OR为22；>17分的OR为41）以及需要机械通气（OR，4.4）。患脑膜炎的患者中，26%死亡。在无脑膜炎的肺炎患者中，累及≥2个肺叶的患者有19%死亡，仅累及1个肺叶的患者有7%死亡（P = 0.0016）。各中心的病死率差异显著：美国和西班牙为20%，英国为13%，瑞典为8%，加拿大为6%。疾病严重程度以及基础慢性病的频率和影响的差异是导致不同结局的可能重要因素。
