Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305-5236, USA.
Int J Infect Dis. 2011 Jun;15(6):e382-7. doi: 10.1016/j.ijid.2011.02.002. Epub 2011 Mar 9.
While studies have demonstrated higher medium-term mortality for community-acquired pneumonia (CAP), mortality and costs have not been characterized for healthcare-associated pneumonia (HCAP) over a 1-year period.
We conducted a retrospective cohort study to evaluate mortality rates and health system costs for patients with CAP or HCAP during initial hospitalization and for 1 year after hospital discharge. We selected 50 758 patients admitted to the Veterans Affairs (VA) healthcare system between October 2003 and May 2007. Main outcome measures included hospital, post-discharge, and cumulative mortality rates and cost during initial hospitalization and at 12 months following discharge.
Hospital and 1-year HCAP mortality were nearly twice that of CAP. HCAP was an independent predictor for hospital mortality (odds ratio (OR) 1.62, 95% confidence interval (CI) 1.49-1.76) and 1-year mortality (OR 1.99, 95% CI 1.87-2.11) when controlling for demographics, comorbidities, pneumonia severity, and factors associated with multidrug-resistant infection, including immune suppression, previous antibiotic treatment, and aspiration pneumonia. HCAP patients consistently had higher mortality in each stratum of the Charlson-Deyo-Quan comorbidity index. HCAP patients incurred significantly greater cost during the initial hospital stay and in the following 12 months. Demographics and comorbid conditions, particularly aspiration pneumonia, accounted for 19-33% of this difference.
HCAP represents a distinct category of pneumonia with particularly poor survival up to 1 year after hospital discharge. While comorbidities, pneumonia severity, and risk factors for multidrug-resistant infection may interact to produce even higher mortality compared to CAP, they alone do not explain the observed differences.
虽然已有研究表明社区获得性肺炎（CAP）的中期死亡率较高，但在 1 年内，医疗相关性肺炎（HCAP）的死亡率和成本尚未得到明确描述。
我们进行了一项回顾性队列研究，以评估 CAP 或 HCAP 患者在初始住院期间和出院后 1 年的死亡率和卫生系统成本。我们选择了 2003 年 10 月至 2007 年 5 月期间在退伍军人事务部（VA）医疗系统住院的 50758 名患者。主要观察指标包括住院期间、出院后以及初始住院期间和出院后 12 个月的累计死亡率和成本。
HCAP 的住院和 1 年死亡率几乎是 CAP 的两倍。在控制人口统计学、合并症、肺炎严重程度以及与多药耐药感染相关的因素（包括免疫抑制、既往抗生素治疗和吸入性肺炎）后，HCAP 是医院死亡率（比值比（OR）1.62，95%置信区间（CI）1.49-1.76）和 1 年死亡率（OR 1.99，95% CI 1.87-2.11）的独立预测因素。在 Charlson-Deyo-Quan 合并症指数的每个分层中，HCAP 患者的死亡率始终较高。HCAP 患者在初始住院期间和随后的 12 个月内的医疗费用显著更高。人口统计学和合并症，特别是吸入性肺炎，占这一差异的 19%-33%。
HCAP 是一种独特的肺炎类别，出院后 1 年内的生存率特别差。虽然合并症、肺炎严重程度以及多药耐药感染的危险因素可能相互作用，导致死亡率比 CAP 更高，但它们本身并不能解释所观察到的差异。
