社区获得性肺炎对老年人健康相关生活质量的影响。
The impact of community-acquired pneumonia on the health-related quality-of-life in elderly.
作者信息
Mangen Marie-Josée J, Huijts Susanne M, Bonten Marc J M, de Wit G Ardine
机构信息
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
Department Respiratory Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
出版信息
BMC Infect Dis. 2017 Mar 14;17(1):208. doi: 10.1186/s12879-017-2302-3.
BACKGROUND
The sustained health-related quality-of-life of patients surviving community-acquired pneumonia has not been accurately quantified. The aim of the current study was to quantify differences in health-related quality-of-life of community-dwelling elderly with and without community-acquired pneumonia during a 12-month follow-up period.
METHODS
In a matched cohort study design, nested in a prospective randomized double-blind placebo-controlled trial on the efficacy of the 13-valent pneumococcal vaccine in community-dwelling persons of ≥65 years, health-related quality-of-life was assessed in 562 subjects hospitalized with suspected community-acquired pneumonia (i.e. diseased cohort) and 1145 unaffected persons (i.e. non-diseased cohort) matched to pneumonia cases on age, sex, and health status (EQ-5D-3L-index). Health-related quality-of-life was determined 1-2 weeks after hospital discharge/inclusion and 1, 6 and 12 months thereafter, using Euroqol EQ-5D-3L and Short Form-36 Health survey questionnaires. One-year quality-adjusted life years (QALY) were estimated for both diseased and non-diseased cohorts. Separate analyses were performed for pneumonia cases with and without radiologically confirmed community-acquired pneumonia.
RESULTS
The one-year excess QALY loss attributed to community-acquired pneumonia was 0.13. Mortality in the post-discharge follow-up year was 8.4% in community-acquired pneumonia patients and 1.2% in non-diseased persons (p < 0.001). During follow-up health-related quality-of-life was persistently lower in community-acquired pneumonia patients, compared to non-diseased persons, but differences in health-related quality-of-life between radiologically confirmed and non-confirmed community-acquired pneumonia cases were not statistically significant.
CONCLUSIONS
Community-acquired pneumonia was associated with a six-fold increased mortality and 16% lower quality-of-life in the post-discharge year among patients surviving hospitalization for community-acquired pneumonia, compared to non-diseased persons.
TRIAL REGISTRATION
ClinicalTrials.gov, NCT00812084 .
背景
社区获得性肺炎幸存者与健康相关的生活质量尚未得到准确量化。本研究的目的是量化在12个月的随访期内，有和没有社区获得性肺炎的社区居住老年人在健康相关生活质量方面的差异。
方法
在一项匹配队列研究设计中，该研究嵌套于一项关于13价肺炎球菌疫苗对≥65岁社区居住者疗效的前瞻性随机双盲安慰剂对照试验中，对562例因疑似社区获得性肺炎住院的受试者（即患病队列）和1145例未受影响的人（即未患病队列）进行了与健康相关生活质量的评估，这些未受影响的人与肺炎病例在年龄、性别和健康状况（EQ-5D-3L指数）上相匹配。在出院/纳入后1-2周以及此后1、6和12个月，使用欧洲五维度健康量表（EQ-5D-3L）和简短健康调查问卷（Short Form-36 Health survey）确定与健康相关的生活质量。对患病和未患病队列均估计了一年的质量调整生命年（QALY）。对有和没有放射学确诊社区获得性肺炎的肺炎病例进行了单独分析。
结果
归因于社区获得性肺炎的一年额外QALY损失为0.13。社区获得性肺炎患者出院后随访年的死亡率为8.4%，未患病者为1.2%（p<0.001）。在随访期间，社区获得性肺炎患者的健康相关生活质量持续低于未患病者，但放射学确诊和未确诊的社区获得性肺炎病例在健康相关生活质量方面的差异无统计学意义。
结论
与未患病者相比，社区获得性肺炎住院幸存者在出院后一年的死亡率增加了6倍，生活质量降低了16%。
试验注册
ClinicalTrials.gov，NCT00812084 。
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