Barnett Mitchell J, Perry Paul J, Alexander Bruce, Kaboli Peter J
The Center for Research in the Implementation of Innovative Strategies in Practice, Iowa City Veterans Administration Hospital, Iowa City, IA 52246, USA.
J Clin Psychopharmacol. 2006 Apr;26(2):182-7. doi: 10.1097/01.jcp.0000203598.43314.34.
To evaluate the use of typical and atypical antipsychotic medications and associated in-hospital mortality in a group of Veterans Administration (VA) patients with pneumonia.
Our cohort consisted of 14,057 VA patients admitted for pneumonia in fiscal year (FY) 2003. Exposure to typical and atypical antipsychotics and other neuropsychiatric drugs was based on a prescription within 120 days preceding admission. Multivariate models determined the odds of mortality associated with each drug class and risk adjusted for comorbidity, admission source, demographic factors, and concurrent mental health conditions. The referent group for each analysis was pneumonia patients not receiving neuropsychiatric drugs.
In adjusted analyses, the odds of in-hospital mortality for VA patients admitted with pneumonia was higher for recent exposure to typical antipsychotics (OR = 1.51, 95% CI = 1.04-2.19; P = 0.03) when compared to patients not receiving neuropsychiatric medications. Patients exposed to atypical antipsychotics (OR = 1.20, 95% CI = 0.96-1.50, P = .10), tricyclic antidepressants (OR = 1.20, 95% CI = 0.44-1.55; P = 0.15), other antidepressants (OR = 1.07, 95% CI = 0.93-1.23; P = 0.37), or mood stabilizers (OR = 0.91, 95% CI = 0.73-1.14; P = 0.41) had no significant difference in in-hospital mortality.
In spite of recent safety concerns for atypical antipsychotics, we found no increased risk of mortality in acutely ill pneumonia patients. Rather, we found a higher adjusted mortality rate for patients taking typical antipsychotics. The contrasting mortality risks for patients taking typical and atypical antipsychotics may represent unmeasured severity of illness or comorbidity. Regardless, any antipsychotics should be used with caution and the efficacy and safety of alternative agents should be considered.
评估一组患有肺炎的退伍军人管理局（VA）患者中典型和非典型抗精神病药物的使用情况以及相关的院内死亡率。
我们的队列包括2003财年因肺炎入院的14,057名VA患者。根据入院前120天内的处方确定是否接触典型和非典型抗精神病药物以及其他神经精神药物。多变量模型确定了与每种药物类别相关的死亡几率，并针对合并症、入院来源、人口统计学因素和并发精神健康状况进行了风险调整。每次分析的参照组为未接受神经精神药物治疗的肺炎患者。
在调整分析中，与未接受神经精神药物治疗的患者相比，近期接触典型抗精神病药物的VA肺炎患者的院内死亡几率更高（OR = 1.51，95% CI = 1.04 - 2.19；P = 0.03）。接触非典型抗精神病药物（OR = 1.20，95% CI = 0.96 - 1.50，P = 0.10）、三环类抗抑郁药（OR = 1.20，95% CI = 0.44 - 1.55；P = 0.15）、其他抗抑郁药（OR = 1.07，95% CI = 0.93 - 1.23；P = 0.37）或心境稳定剂（OR = 0.91，95% CI = 0.73 - 1.14；P = 0.41）的患者在院内死亡率方面无显著差异。
尽管近期对非典型抗精神病药物存在安全性担忧，但我们发现急性病肺炎患者的死亡风险并未增加。相反，我们发现服用典型抗精神病药物的患者调整后的死亡率更高。服用典型和非典型抗精神病药物的患者死亡率风险的差异可能代表了未测量的疾病严重程度或合并症。无论如何，任何抗精神病药物都应谨慎使用，并应考虑替代药物的疗效和安全性。
