Igari Hidetoshi, Yamagishi Kazutaka, Yamazaki Shingo, Murata Shota, Yahaba Misuzu, Takayanagi Shin, Kawasaki Yohei, Taniguchi Toshibumi
Division of Infection Control, Chiba University Hospital, 1-8-1 Inohana Chuo-Ku, Chiba, 260-8677, Japan.
Division of Pharmacy, Chiba University Hospital, 1-8-1 Inohana Chuo-Ku, Chiba, 260-8677, Japan.
J Infect Chemother. 2020 Jan;26(1):58-62. doi: 10.1016/j.jiac.2019.07.001. Epub 2019 Jul 25.
Pneumonia is the third leading cause of death in Japan. Mortality increases at an accelerating rate in elderly patients aged ≥65 years. Elderly patients tend to have underlying conditions affecting pneumonia treatment. The national database (NDB) associated with medical services under Japanese universal health insurance is available for research purposes. Our NDB randomly sampled 10% of hospitalized patients every October from 2011 to 2014. In this NDB, we analyzed pneumonia epidemiology in patients aged ≥15 years and 30-day mortality in Japanese hospitals. This study also investigated the factors affecting treatment outcome. A total of 9386 patients were entered. The number of patients from age 65 years and older increased greatly, representing 85% of the total. The thirty-day mortality rate among all patients was 11.7%. Mortality rates at age 15-64, 65-74, 75-84, and ≥85 years were 9.5%, 12.0%, 8.3%, and 14.9%, respectively, showing significant differences (P < 0.001). The underlying conditions varied among age groups. Male gender, age, heart failure, chronic kidney disease (CKD), consciousness disorder, shock and respiratory failure are risk factors for 30-day mortality. Pneumonia develops mainly in people aged 65 years and older in Japan, and treatment outcome is generally poor in elderly patients. The underlying conditions were seen to affect the 30-day mortality rate. CURB-65 and ADROP, a modification of CURB-65 in Japan, have already estimated these risk factors, and heart failure and CKD might be additional factors for estimating pneumonia severity.
肺炎是日本第三大死因。在65岁及以上的老年患者中，死亡率呈加速上升趋势。老年患者往往存在影响肺炎治疗的基础疾病。与日本全民健康保险下的医疗服务相关的国家数据库可供研究使用。我们的国家数据库在2011年至2014年期间，每年10月从住院患者中随机抽取10%的样本。在这个国家数据库中，我们分析了15岁及以上患者的肺炎流行病学情况以及日本医院中患者的30天死亡率。本研究还调查了影响治疗结果的因素。共有9386名患者被纳入研究。65岁及以上的患者数量大幅增加，占总数的85%。所有患者的30天死亡率为11.7%。15 - 64岁、65 - 74岁、75 - 84岁和85岁及以上患者的死亡率分别为9.5%、12.0%、8.3%和14.9%，差异有统计学意义（P < 0.001）。不同年龄组的基础疾病各不相同。男性、年龄、心力衰竭、慢性肾脏病（CKD）、意识障碍、休克和呼吸衰竭是导致30天死亡率的危险因素。在日本，肺炎主要发生在65岁及以上的人群中，老年患者的治疗结果总体较差。基础疾病被认为会影响30天死亡率。CURB - 65以及日本对CURB - 65的改良版ADROP已经对这些危险因素进行了评估，心力衰竭和CKD可能是评估肺炎严重程度的额外因素。
