Braeken Dionne C W, Franssen Frits M E, Schütte Hartwig, Pletz Mathias W, Bals Robert, Martus Peter, Rohde Gernot G U
Department of Research and Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, the Netherlands.
Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands.
Chronic Obstr Pulm Dis. 2015 Mar 26;2(2):131-140. doi: 10.15326/jcopdf.2.2.2014.0149.
Mortality of community acquired pneumonia (CAP) remains high despite significant research efforts. Knowledge about comorbidities including chronic obstructive pulmonary disease (COPD) might help to improve management and ultimately, survival. The impact of COPD on CAP severity and mortality remains a point of discussion. Assess the prevalence and clinical characteristics of COPD in the observational German Competence Network for CAP, CAPNETZ, and to study the impact of COPD on CAP severity and mortality. 1307 consecutive patients with CAP (57.0% males, age 59.0±18.5), classified as CAP-only (n=1043; 78.0%) and CAP-COPD (n=264; 20.2%) were followed up for 180 days. Associations between CAP, COPD and mortality were evaluated by univariate/multivariate and Kaplan-Meier survival analyses. CAP-COPD patients were older, more often males, current/former smokers, with higher confusion-urea-respiratory rate-blood pressure, (CURB) scores. Length of hospital stay, urea, glucose and leucocytes plasma levels, and arterial carbon dioxide tension (PaCO) were significantly increased in CAP-COPD. Thirty, 90- and 180-day mortality rates were significantly increased in CAP-COPD (=0.046, odds ratio [OR]=2.48, 95% confidence interval [CI] 1.015-6.037; =0.003, OR=2.80, 95%CI 1.430-5.468; =0.001, OR=2.57, 95%CI 1.462-4.498; respectively). Intensive care unit (ICU)-admission and age, but not COPD, were identified as independent predictors of short- and long-term mortality. Severity as well as mortality was significantly higher in COPD patients with CAP. To improve CAP management with the aim to decrease its still-too-high mortality, underlying comorbidities, particularly COPD, need to be assessed.
尽管进行了大量研究，但社区获得性肺炎（CAP）的死亡率仍然很高。了解包括慢性阻塞性肺疾病（COPD）在内的合并症可能有助于改善治疗并最终提高生存率。COPD对CAP严重程度和死亡率的影响仍是一个讨论点。评估德国CAP观察性能力网络CAPNETZ中COPD的患病率和临床特征，并研究COPD对CAP严重程度和死亡率的影响。对1307例连续的CAP患者（男性占57.0%，年龄59.0±18.5岁）进行了为期180天的随访，这些患者分为单纯CAP组（n=1043；78.0%）和CAP-COPD组（n=264；20.2%）。通过单因素/多因素分析和Kaplan-Meier生存分析评估CAP、COPD与死亡率之间的关联。CAP-COPD患者年龄更大，男性更多，是当前/既往吸烟者，具有更高的意识模糊-尿素-呼吸频率-血压（CURB）评分。CAP-COPD患者的住院时间、尿素、血糖和白细胞血浆水平以及动脉二氧化碳分压（PaCO）显著升高。CAP-COPD患者的30天、90天和180天死亡率显著升高（分别为P=0.046，比值比[OR]=2.48，95%置信区间[CI]1.015-6.037；P=0.003，OR=2.80,95%CI 1.430-5.468；P=0.001，OR=2.57,95%CI 1.462-4.498）。重症监护病房（ICU）入院和年龄，但不是COPD，被确定为短期和长期死亡率的独立预测因素。合并CAP的COPD患者的严重程度和死亡率显著更高。为了改善CAP的治疗以降低其仍然过高的死亡率，需要评估潜在的合并症，特别是COPD。
