1Département d'Anesthésie-Réanimation, CHU Bichat-Claude Bernard, Université Paris VII, Assistance Publique Hopitaux de Paris, France. 2Université Paris Diderot, Sorbonne Paris Cité, Paris, France. 3Unité d'Hygiène et de lutte Contre les Infections Hospitalières, CHU Bichat-Claude Bernard, Université Paris VII, Assistance Publique Hopitaux de Paris, France. 4Service de Biostatistique, F-75018, CHU Bichat-Claude Bernard, Université Paris VII, Assistance Publique Hopitaux de Paris, France.
Crit Care Med. 2014 May;42(5):1150-6. doi: 10.1097/CCM.0000000000000143.
The aims of this study were, first, to identify risk factors for microbiology-proven postoperative pneumonia after cardiac surgery and, second, to develop and validate a preoperative scoring system for the risk of postoperative pneumonia.
A single-center cohort study.
All consecutive patients undergoing cardiac surgery between January 2006 and July 2011.
None.
Multivariate analysis of risk factors for postoperative pneumonia was performed on data from patients operated between January 2006 and December 2008 (training set). External temporal validation was performed on data from patients operated between January 2009 and July 2011 (validation set). Preoperative variables identified in multivariate analysis of the training set were then used to develop a preoperative scoring system that was validated on the validation set. Postoperative pneumonia occurred in 174 of the 5,582 patients (3.1%; 95% CI, 2.7-3.6). Multivariate analysis identified four risk factors for postoperative pneumonia: age (odds ratio, 1.02; 95% CI, 1.01-1.03), chronic obstructive pulmonary disease (odds ratio, 2.97; 95% CI, 1.8-4.71), preoperative left ventricular ejection fraction (odds ratio, 0.98; 95% CI, 0.96-0.99), and the interaction between RBC transfusion during surgery and duration of cardiopulmonary bypass (odds ratio, 2.98; 95% CI, 1.96-4.54). A 6-point score including the three preoperative variables then defined two risk groups corresponding to postoperative pneumonia rates of 1.8% (score < 3) and 6.5% (score ≥ 3).
Assessing preoperative risk factors for postoperative pneumonia with the proposed scoring system could help to implement a preventive policy in high-risk patients with a risk of postoperative pneumonia greater than 4% (i.e., patients with a score ≥ 3).
本研究的目的首先是确定心脏手术后微生物学确诊的术后肺炎的危险因素，其次是开发和验证一种用于预测术后肺炎风险的术前评分系统。
单中心队列研究。
2006 年 1 月至 2011 年 7 月期间连续接受心脏手术的所有患者。
无。
对 2006 年 1 月至 2008 年 12 月期间手术的患者数据（训练集）进行了术后肺炎危险因素的多变量分析。对 2009 年 1 月至 2011 年 7 月期间手术的患者数据（验证集）进行了外部时间验证。然后，将多变量分析中确定的术前变量用于开发术前评分系统，并在验证集上进行验证。5582 例患者中有 174 例（3.1%；95%CI，2.7-3.6）发生术后肺炎。多变量分析确定了术后肺炎的四个危险因素：年龄（比值比，1.02；95%CI，1.01-1.03）、慢性阻塞性肺疾病（比值比，2.97；95%CI，1.8-4.71）、术前左心室射血分数（比值比，0.98；95%CI，0.96-0.99）和手术期间红细胞输注与体外循环持续时间之间的相互作用（比值比，2.98；95%CI，1.96-4.54）。然后，包含这三个术前变量的 6 分评分定义了两个风险组，与术后肺炎发生率为 1.8%（评分<3）和 6.5%（评分≥3）相对应。
使用所提出的评分系统评估术后肺炎的术前危险因素可以帮助对术后肺炎风险大于 4%（即评分≥3）的高危患者实施预防策略。
