University of Louisville, School of Medicine, Department of Medicine, Division of Infectious Diseases, 501 E. Broadway, Suite 120, Louisville, KY 40292, USA.
Respir Med. 2013 Jul;107(7):1101-11. doi: 10.1016/j.rmed.2013.04.003. Epub 2013 May 6.
Community-acquired pneumonia (CAP) causes considerable worldwide mortality, but limited data compare the mortality in different regions of the world. Our objective was to determine if there was a difference in mortality among hospitalized patients with CAP in three continental regions of the world.
This was a cohort study of patients hospitalized for CAP between November 2001 and December 2011 from 70 institutions in 16 countries in US/Canada, Europe and Latin America; the Community-Acquired Pneumonia Organization (CAPO) international database. The primary outcome was mortality, and factors of interest included world region, processes of care, severity of disease, associated pathogen, specific comorbidities, and antimicrobial therapy. Multivariable logistic regression was performed to adjust for confounding effects on differences in mortality between regions. Patients were analyzed separately based on their intensive care unit admission status.
A total of 6371 patients were reviewed. Latin America had the highest mortality (13.3%) followed by Europe (9.1%) and the USA/Canada (7.3%) (P < 0.001 for differences between regions). Important confounding variables included comorbidities (i.e., congestive heart failure, cerebrovascular disease), elevated blood urea nitrogen level, antimicrobial therapy (macrolide or fluoroquinolone use), and whether the patient had prior vaccinations (influenza, pneumococcal). After adjustment for confounding variables, estimated differences in mortality between the three regions were significantly reduced for both patients in the ICU and the ward.
There was an observed discrepancy in CAP mortality between three world regions. Identified factors that contributed to these differences included incidence of H1N1 infection, elevated BUN, cerebrovascular disease, macrolide use, fluoroquinolone use, and vaccinations. Treatment regimen (fluoroquinolone and macrolide use) and preventive measures (vaccinations) were variables that may be modified to help alleviate the differences.
社区获得性肺炎（CAP）在全球范围内导致了相当大的死亡率，但有关世界不同地区死亡率的数据有限。我们的目的是确定世界三个大陆地区住院 CAP 患者的死亡率是否存在差异。
这是一项队列研究，纳入了 2001 年 11 月至 2011 年 12 月期间来自美国/加拿大、欧洲和拉丁美洲 16 个国家的 70 家机构的 6371 例因 CAP 住院的患者；该研究来自社区获得性肺炎组织（CAPO）国际数据库。主要结局是死亡率，感兴趣的因素包括世界区域、治疗过程、疾病严重程度、相关病原体、特定合并症和抗菌治疗。采用多变量逻辑回归来调整区域间死亡率差异的混杂因素。根据患者是否入住重症监护病房（ICU），分别对患者进行分析。
共回顾了 6371 例患者。拉丁美洲的死亡率最高（13.3%），其次是欧洲（9.1%）和美国/加拿大（7.3%）（区域间差异有统计学意义，P<0.001）。重要的混杂变量包括合并症（充血性心力衰竭、脑血管疾病）、血尿素氮水平升高、抗菌治疗（大环内酯类或氟喹诺酮类药物使用）以及患者是否接种过疫苗（流感、肺炎球菌）。在调整混杂变量后，ICU 和普通病房患者的死亡率差异明显降低。
在三个世界区域之间观察到 CAP 死亡率存在差异。导致这些差异的因素包括 H1N1 感染、血尿素氮升高、脑血管疾病、大环内酯类药物使用、氟喹诺酮类药物使用和疫苗接种。治疗方案（氟喹诺酮类和大环内酯类药物使用）和预防措施（疫苗接种）是可能改变以帮助减轻差异的变量。
