Gómez-Junyent Joan, Garcia-Vidal Carolina, Viasus Diego, Millat-Martínez Pere, Simonetti Antonella, Santos Ma Salud, Ardanuy Carmen, Dorca Jordi, Carratalà Jordi
Department of Infectious Diseases, Hospital Universitari de Bellvitge, University of Barcelona, and Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain.
Department of Infectious Diseases, Hospital Universitari de Bellvitge, University of Barcelona, and Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain; REIPI (Spanish Network for the Research in Infectious Diseases), Instituto de Salud Carlos III, Madrid, Spain.
PLoS One. 2014 Aug 28;9(8):e105854. doi: 10.1371/journal.pone.0105854. eCollection 2014.
Community-acquired pneumonia (CAP) is a frequent complication of chronic obstructive pulmonary disease (COPD), but previous studies are often contradictory.
We aimed to ascertain the characteristics and outcomes of CAP in patients with COPD as well as to determine the risk factors for mortality and Pseudomonas aeruginosa pneumonia in COPD patients with CAP. We also describe the etiology and outcomes of CAP in COPD patients receiving chronic oxygen therapy at home and those receiving inhaled steroids.
An observational analysis of a prospective cohort of hospitalized adults with CAP (1995-2011) was performed.
We documented 4121 CAP episodes, of which 983 (23.9%) occurred in patients with COPD; the median FEV1 value was 50%, and 57.8% were classified as stage III or IV in the GOLD classification. Fifty-eight per cent of patients were receiving inhaled steroids, and 14.6% chronic oxygen therapy at home. Patients with COPD presented specific clinical features. S. pneumoniae was the leading causative organism overall, but P. aeruginosa was more frequent in COPD (3.4 vs. 0.5%; p<0.001). Independent risk factors for case-fatality rate in patients with COPD were multilobar pneumonia, P. aeruginosa pneumonia, and high-risk PSI classes. Prior pneumococcal vaccination was found to be protective. FEV1 was an independent risk factor for P. aeruginosa pneumonia.
CAP in patients with COPD presents specific characteristics and risk factors for mortality. Prior pneumococcal vaccine has a beneficial effect on outcomes. P. aeruginosa pneumonia is associated with low FEV1 values and poor prognosis.
社区获得性肺炎（CAP）是慢性阻塞性肺疾病（COPD）常见的并发症，但既往研究结果常相互矛盾。
我们旨在明确COPD患者中CAP的特征及转归，确定COPD合并CAP患者死亡及铜绿假单胞菌肺炎的危险因素。我们还描述了在家接受长期氧疗的COPD患者及接受吸入性糖皮质激素治疗的COPD患者中CAP的病因及转归。
对1995 - 2011年住院的成年CAP患者前瞻性队列进行观察性分析。
我们记录了4121例CAP发作，其中983例（23.9%）发生在COPD患者中；FEV1中位数为50%，57.8%在GOLD分级中被分类为III或IV期。58%的患者接受吸入性糖皮质激素治疗，14.6%在家接受长期氧疗。COPD患者呈现出特定的临床特征。肺炎链球菌是总体上主要的致病原，但铜绿假单胞菌在COPD患者中更常见（3.4%对0.5%；p<0.001）。COPD患者病死率的独立危险因素为多叶肺炎、铜绿假单胞菌肺炎及高危PSI分级。发现既往接种肺炎球菌疫苗具有保护作用。FEV1是铜绿假单胞菌肺炎的独立危险因素。
COPD患者的CAP具有特定特征及死亡危险因素。既往肺炎球菌疫苗对转归有有益影响。铜绿假单胞菌肺炎与低FEV1值及不良预后相关。
