COPD 对社区获得性肺炎死亡率和严重程度评分的影响。

The influence of COPD on mortality and severity scoring in community-acquired pneumonia.

机构信息

Department of Pulmonary Diseases, Medical Center Alkmaar, Alkmaar, The Netherlands.

出版信息

Respiration. 2010;79(1):46-53. doi: 10.1159/000213757. Epub 2009 Apr 16.

DOI:10.1159/000213757

PMID:19372638

Abstract

BACKGROUND

Chronic obstructive lung disease (COPD) is a frequent co-morbidity in patients hospitalised with community-acquired pneumonia (CAP). In recent retrospective studies, higher mortality in patients with CAP and COPD was found.

OBJECTIVES

The aim of the study was to determine the 30-day mortality and to evaluate the differences in CAP severity scoring in hospitalised patients with COPD.

METHODS

A subanalysis of a randomized clinical trial was performed.

RESULTS

A total of 262 patients with CAP were included. Ninety-five (36.3%) patients had COPD. A total of 28 (10.7%) patients died within 30 days. No differences between patients with and without COPD in 30-day mortality were observed [8 (8.4%) vs. 20 (12.0%), p = 0.37]. In the Pneumonia Severity Index (PSI), significant differences in age, gender and heart rate between patients with and without COPD were observed. Patients with COPD were stratified in higher PSI classes. In the CURB-65 score, age >or=65 years was significantly higher in patients with COPD [72 (75.8%) vs. 88 (52.7%), p = <0.01]. In a multivariate analysis, only the need for intensive care unit admission and high serum glucose were predictors of mortality [OR 32.50 (95% CI 6.87-153.75), p < 0.01; OR 7.34 (95% CI 1.19-45.4), p = 0.03].

CONCLUSIONS

Mortality was not increased in patients with COPD hospitalised with CAP. Severity scores are influenced by age and gender. Further studies evaluating CAP in patients with COPD are needed to explain these findings.

摘要

背景

慢性阻塞性肺病（COPD）是社区获得性肺炎（CAP）住院患者常见的合并症。在最近的回顾性研究中，发现 CAP 和 COPD 患者的死亡率更高。

目的

本研究旨在确定 30 天死亡率，并评估 COPD 住院患者 CAP 严重程度评分的差异。

方法

对一项随机临床试验进行了亚分析。

结果

共纳入 262 例 CAP 患者，其中 95 例（36.3%）患有 COPD。共有 28 例（10.7%）患者在 30 天内死亡。COPD 患者与无 COPD 患者的 30 天死亡率无差异[8（8.4%）与 20（12.0%），p=0.37]。在肺炎严重指数（PSI）中，COPD 患者与无 COPD 患者在年龄、性别和心率方面存在显著差异。COPD 患者的 PSI 分级更高。在 CURB-65 评分中，COPD 患者年龄≥65 岁的比例明显更高[72（75.8%）与 88（52.7%），p<0.01]。多变量分析显示，仅需要入住重症监护病房和高血糖是死亡的预测因素[OR 32.50（95%CI 6.87-153.75），p<0.01；OR 7.34（95%CI 1.19-45.4），p=0.03]。