COPD 对 ICU 获得性肺炎（有无先前插管）结局的影响。
Impact of COPD in the outcome of ICU-acquired pneumonia with and without previous intubation.
机构信息
Servei de Pneumologia, Institut del Torax, Hospital Clinic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.
Servei de Pneumologia, Institut del Torax, Hospital Clinic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomedica En Red-Enfermedades Respiratorias, Barcelona, Spain (CibeRes, CB06/06/0028).
出版信息
Chest. 2015 Jun;147(6):1530-1538. doi: 10.1378/chest.14-2005.
BACKGROUND
COPD seems related to poor outcome in patients with ventilator-associated pneumonia (VAP). However, many patients in the ICU with COPD do not require intubation but can also develop pneumonia in the ICU. We, therefore, compared the characteristics and outcomes of patients with ICU-acquired pneumonia (ICUAP) with and without underlying COPD.
METHODS
We prospectively assessed the characteristics, microbiology, systemic inflammatory response, and survival of 279 consecutive patients with ICUAP clustered according to underlying COPD or not. The primary end point was 90-day survival.
RESULTS
Seventy-one patients (25%) had COPD. The proportion of VAP was less frequent in patients with COPD: 30 (42%) compared with 126 (61%) in patients without COPD (P = .011). Patients with COPD were older; were more frequently men, smokers, and alcohol abusers; and more frequently had previous use of noninvasive ventilation. The rate of microbiologic diagnosis was similar between groups, with a higher rate of Aspergillus species and a lower rate of Enterobacteriaceae in patients with COPD. We found lower levels of IL-6 and IL-8 in patients with COPD without previous intubation. The 90-day mortality was higher in patients with COPD (40 [57%] vs 74 [37%] in patients without COPD, P = .003). Among others, COPD was independently associated with decreased 90-day survival in the overall population (adjusted hazard ratio, 1.94; 95% CI, 1.11-3.40; P = .020); this association was observed only in patients with VAP but not in those without previous intubation.
CONCLUSIONS
COPD was independently associated with decreased 90-day survival in patients with VAP but not in those without previous intubation.
背景
慢性阻塞性肺疾病（COPD）似乎与呼吸机相关性肺炎（VAP）患者的不良预后有关。然而，许多 ICU 中有 COPD 的患者不需要插管，但也可能在 ICU 中发生肺炎。因此，我们比较了有和无潜在 COPD 的 ICU 获得性肺炎（ICUAP）患者的特征和结局。
方法
我们前瞻性评估了 279 例连续 ICUAP 患者的特征、微生物学、全身炎症反应和生存情况，这些患者根据潜在 COPD 分为有和无 COPD 两组。主要终点是 90 天生存率。
结果
71 例（25%）患者有 COPD。有 COPD 患者的 VAP 比例较低：30 例（42%）比无 COPD 患者的 126 例（61%）（P =.011）。有 COPD 的患者年龄较大；更常见的是男性、吸烟者和酗酒者；且更频繁地使用过无创通气。两组的微生物学诊断率相似，但有 COPD 且无先前插管的患者中，曲霉菌种的检出率较高，肠杆菌科的检出率较低。我们发现，无先前插管的 COPD 患者的 IL-6 和 IL-8 水平较低。有 COPD 的患者 90 天死亡率较高（40 [57%] 比无 COPD 的患者 74 [37%]，P =.003）。在其他因素中，COPD 与总体人群的 90 天生存率降低独立相关（调整后的危险比，1.94；95%CI，1.11-3.40；P =.020）；这种关联仅见于 VAP 患者，而不在于无先前插管的患者。
结论
在 VAP 患者中，COPD 与 90 天生存率降低独立相关，但在无先前插管的患者中则不然。
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