Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan.
Institute of Public Health and Department of Public Health, National Yang-Ming University, Taipei, Taiwan.
Psychiatry Clin Neurosci. 2018 May;72(5):337-348. doi: 10.1111/pcn.12636. Epub 2018 Feb 7.
Patients with bipolar disorder (BD) tend to have poorer outcomes after pneumonia and could have a higher risk for recurrence of pneumonia. We aimed to investigate the incidence and risk factors of recurrent pneumonia in patients with BD.
In a nationwide cohort of BD patients (derived from the National Health Insurance Research Database in Taiwan) who were hospitalized for pneumonia between 1996 and 2012, we identified 188 patients who developed recurrent pneumonia after a baseline pneumonia episode. Applying risk-set sampling at a 1:2 ratio, 353 matched controls were selected from the study cohort. We used multivariate conditional logistic regression analysis to explore the association between recurrent pneumonia and physical illness, concomitant medications, and psychotropic drugs.
The findings showed that the incidence of recurrent pneumonia in BD was 6.60 cases per 100 person-years, which was higher than that in the general population. About 10% (9.24%) of cases with recurrent pneumonia died within 30 days of hospitalization. Patients had increased risk of recurrent pneumonia if they had hypertension, diabetes mellitus, cancer, or asthma. Conversely, psychotropic drugs, both first- and second-generation antipsychotics, which are known to increase susceptibility to baseline pneumonia, were not associated with risk of pneumonia recurrence.
We found an excess incidence of recurring pneumonia in patients with BD, and this risk was associated with pre-existing medical conditions but not psychotropic agents. Physicians should carefully consider the comorbid medical conditions of patients with BD that could lead to recurrent pneumonia.
患有双相情感障碍（BD）的患者在肺炎后往往预后较差，并且肺炎复发的风险可能更高。我们旨在调查 BD 患者肺炎复发的发生率和危险因素。
在一个全国性的 BD 患者队列中（源自台湾的全民健康保险研究数据库），这些患者在 1996 年至 2012 年间因肺炎住院，我们确定了 188 名在基线肺炎发作后发生肺炎复发的患者。应用风险集抽样，以 1:2 的比例，从研究队列中选择了 353 名匹配对照。我们使用多变量条件逻辑回归分析来探讨肺炎复发与躯体疾病、伴随药物和精神药物之间的关系。
研究结果显示，BD 患者肺炎复发的发生率为每 100 人年 6.60 例，高于普通人群。约 10%（9.24%）的肺炎复发患者在住院后 30 天内死亡。如果患者患有高血压、糖尿病、癌症或哮喘，他们发生肺炎复发的风险会增加。相反，精神药物，包括第一代和第二代抗精神病药物，已知会增加基线肺炎的易感性，但与肺炎复发的风险无关。
我们发现 BD 患者肺炎复发的发生率过高，这种风险与既往的合并症有关，而与精神药物无关。医生应仔细考虑可能导致肺炎复发的 BD 患者的合并症。
