Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, USA.
Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala.
BMC Public Health. 2019 May 3;19(1):499. doi: 10.1186/s12889-019-6824-z.
Acute respiratory infection (ARI) is an important cause of mortality in children and adults. However, studies assessing risk factors for ARI-related deaths in low- and middle-income settings are limited. We describe ARI-related death and associated factors among children aged < 2 years and adults aged ≥18 years hospitalized with ARI in Guatemala.
We used respiratory illness surveillance data in Guatemala from 2007 to 2013. ARI was defined as evidence of acute infection and ≥ 1 sign/symptom of respiratory disease in hospitalized patients. Clinical, sociodemographic, and follow-up data were gathered. Nasopharyngeal/oropharyngeal swabs were collected from patients with ARI and tested for 6 respiratory viruses; urine was collected only from adults with ARI and tested for pneumococcal antigen. Blood cultures and chest radiographs were performed at the physician's discretion. Radiographs were interpreted per World Health Organization guidelines to classify endpoint pneumonia (i.e. suggestive of bacterial pneumonia). Multivariable logistic regression was used to compare characteristics of patients with fatal cases, including those who died in-hospital or were discharged in a moribund state, with those of patients with non-fatal cases.
Among 4109 ARI cases identified in hospitalized children < 2 years old, 174 (4%) were fatal. Median age at admission was 4 and 6 months for children with fatal and non-fatal cases, respectively. Factors associated with fatality included low weight-for-age, low family income, heart disease, and endpoint pneumonia; breastfeeding and respiratory syncytial virus (RSV) detection were negatively associated with fatality. Among 1517 ARI cases identified in hospitalized adults ≥18 years, 181 (12%) episodes were fatal. Median age at admission was 57 years for adults with fatal and non-fatal cases. Low body mass index, male sex, kidney disease, and endpoint pneumonia were significantly more common among patients with fatal versus non-fatal cases.
Our findings highlight some of the factors that must be addressed in order to reduce ARI-related mortality, including promotion of good nutrition, breastfeeding, management and prevention of chronic comorbidities, and poverty reduction. Although no specific pathogen increased risk for death, endpoint pneumonia was significantly associated with fatality, suggesting that the pneumococcal conjugate vaccine could contribute to future reductions in ARI-related mortality.
急性呼吸道感染（ARI）是儿童和成人死亡的重要原因。然而，在中低收入国家评估与 ARI 相关的死亡危险因素的研究有限。我们描述了危地马拉因 ARI 住院的<2 岁儿童和≥18 岁成人的 ARI 相关死亡和相关因素。
我们使用了 2007 年至 2013 年危地马拉的呼吸道疾病监测数据。ARI 的定义为住院患者急性感染的证据和≥1 种呼吸道疾病的体征/症状。收集了临床、社会人口统计学和随访数据。从患有 ARI 的患者中采集鼻咽/口咽拭子，并检测 6 种呼吸道病毒；仅从患有 ARI 的成年人中采集尿液，检测肺炎球菌抗原。根据医生的判断进行血培养和胸部 X 光检查。根据世界卫生组织的指南对 X 光片进行解读，以分类终点肺炎（即提示细菌性肺炎）。采用多变量逻辑回归比较了致命病例和非致命病例患者的特征，包括住院期间死亡或出院时生命垂危的病例。
在 4109 例<2 岁因 ARI 住院的儿童中，有 174 例（4%）死亡。致命病例和非致命病例的入院中位年龄分别为 4 个月和 6 个月。与死亡相关的因素包括体重不足、家庭收入低、心脏病和终点肺炎；母乳喂养和呼吸道合胞病毒（RSV）检测与死亡呈负相关。在 1517 例≥18 岁因 ARI 住院的成年人中，有 181 例（12%）发生死亡。致命病例和非致命病例的入院中位年龄分别为 57 岁。体重指数低、男性、肾脏疾病和终点肺炎在死亡病例中比非死亡病例更为常见。
我们的研究结果强调了一些必须加以解决的因素，以降低与 ARI 相关的死亡率，包括促进良好的营养、母乳喂养、管理和预防慢性合并症以及减少贫困。虽然没有特定的病原体增加死亡风险，但终点肺炎与死亡显著相关，这表明肺炎球菌结合疫苗可能有助于未来降低与 ARI 相关的死亡率。
