美国肺炎链球菌感染退伍军人的死亡率预测因素。

Predictors of Mortality Among U.S. Veterans With Streptococcus Pneumoniae Infections.

机构信息

Veterans Affairs Medical Center, Infectious Diseases Research Program and Center of Innovation in Long Term Services and Supports, Providence, Rhode Island; Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island.

出版信息

Am J Prev Med. 2017 Jun;52(6):769-777. doi: 10.1016/j.amepre.2016.10.023. Epub 2016 Dec 14.

DOI:10.1016/j.amepre.2016.10.023

PMID:27988089

Abstract

INTRODUCTION

Serious Streptococcus pneumoniae infections, encompassing pneumonia, bacteremia, and meningitis, are a major cause of mortality. However, literature regarding mortality is often limited to invasive pneumococcal disease, excluding pneumonia. This study sought to identify predictors of mortality among adults with serious pneumococcal disease, including pneumonia and invasive pneumococcal disease.

METHODS

This was a nested case-control study of unvaccinated older Veterans with positive S. pneumoniae cultures (blood, cerebrospinal fluid, respiratory) admitted to Veterans Affairs medical centers nationally between 2002 and 2011. Patients vaccinated against pneumococcal disease were excluded. Using multivariable logistic regression, predictors of 30-day mortality were identified, including patient demographics, comorbidities during admission, and medical history within the previous year.

RESULTS

Among 9,468 patients, there were 9,730 serious pneumococcal infections; 1,764 (18.6%) resulted in death within 30 days (cases), whereas 7,966 did not (controls). Pneumonia accounted for half (49.4%, n=871) of all deaths. Mortality predictors consistent with vaccine recommendations included dialysis (during hospitalization, OR=3.35, 95% CI=2.37, 4.72), moderate to severe liver disease (during hospitalization, OR=2.47, 95% CI=1.53, 3.99; within 1 year, OR=1.49, 95% CI=1.01, 2.20), and neutropenia (during hospitalization, OR=2.67, 95% CI=1.32, 5.42). Predictors not included in current recommendations included dementia (during hospitalization, OR=1.8, 95% CI=1.23, 2.61) and neurologic disorders (during hospitalization, OR=1.86, 95% CI=1.42, 2.45; within 1 year, OR=1.28, 95% CI=1.02, 1.59).

CONCLUSIONS

Several mortality predictors among unvaccinated Veterans with serious pneumococcal disease were consistent with pneumococcal vaccine recommendations, including organ or immune system dysfunction-related conditions. Other predictors, including neurologic disorders or dementia, may warrant expanded vaccination recommendations.

摘要

简介

严重肺炎链球菌感染包括肺炎、菌血症和脑膜炎，是导致死亡的主要原因。然而，关于死亡率的文献通常仅限于侵袭性肺炎球菌病，不包括肺炎。本研究旨在确定患有严重肺炎球菌病（包括肺炎和侵袭性肺炎球菌病）的成年人的死亡预测因素。

方法

这是一项对全国退伍军人事务部医疗中心于 2002 年至 2011 年间收治的未接种疫苗的老年退伍军人的嵌套病例对照研究，这些退伍军人的肺炎链球菌培养（血液、脑脊液、呼吸道）呈阳性。排除接种过肺炎球菌疫苗的患者。使用多变量逻辑回归，确定了 30 天死亡率的预测因素，包括患者人口统计学特征、入院期间的合并症以及前一年的病史。

结果

在 9468 名患者中，有 9730 例严重肺炎球菌感染；其中 1764 例（18.6%）在 30 天内死亡（病例），7966 例未死亡（对照）。肺炎占所有死亡人数的一半（49.4%，n=871）。与疫苗推荐一致的死亡率预测因素包括透析（住院期间，OR=3.35，95%CI=2.37，4.72）、中重度肝疾病（住院期间，OR=2.47，95%CI=1.53，3.99；1 年内，OR=1.49，95%CI=1.01，2.20）和中性粒细胞减少症（住院期间，OR=2.67，95%CI=1.32，5.42）。目前推荐中不包括的预测因素包括痴呆（住院期间，OR=1.8，95%CI=1.23，2.61）和神经系统疾病（住院期间，OR=1.86，95%CI=1.42，2.45；1 年内，OR=1.28，95%CI=1.02，1.59）。