Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan.
Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan.
J Infect Chemother. 2020 Jun;26(6):563-569. doi: 10.1016/j.jiac.2020.01.009. Epub 2020 Feb 14.
Nursing and healthcare-associated pneumonia (NHCAP) is a category of healthcare-associated pneumonia modified for the healthcare system in Japan. To date, only a few studies have examined the prognostic factors of NHCAP in a prospective cohort. This study aimed to investigate the prognostic factors related to 30-day mortality in patients with NHCAP by analyzing prospective data.
We analyzed patients hospitalized for NHCAP who were enrolled between October 2010 and February 2017. Age, sex, comorbidities, vital signs and laboratory findings were used as prognostic variables. The primary outcome was 30-day mortality.
Of 817 NHCAP patients identified, the mean age was 78.0 ± 11.1 years, 580 (71.0%) were men and 30-day mortality was 13.1% (107/817). On multivariate analysis, male sex (odds ratio [OR]: 2.07, 95% confidence interval [CI]: 1.18-3.63), malignancy (OR: 2.35, 95%CI: 1.38-4.01), performance status (PS) (OR: 1.55, 95%CI: 1.23-1.96), body temperature (OR: 0.77, 95%CI: 0.61-0.97), heart rate (OR: 1.02, 95%CI: 1.01-1.03), respiratory rate (OR: 1.04, 95%CI: 1.01-1.08), serum albumin (Alb) (OR: 0.45, 95%CI: 0.30-0.66) and blood urea nitrogen (BUN) (OR: 1.02, 95%CI: 1.01-1.03) were significantly related to 30-day mortality. On the other hand, the risk factors for involvement by drug-resistant pathogens predicted a better prognosis (OR: 0.39, 95%CI: 0.19-0.82).
Male sex, malignancy, poor PS, hypothermia, tachycardia, tachypnea, low serum Alb and high BUN are worse prognostic factors. Thus, the risk of drug-resistant pathogens is not necessarily related to poor prognosis.
医护相关性肺炎（NHCAP）是日本医疗体系中对肺炎进行分类的一种方式。迄今为止，仅有少数研究前瞻性地分析了 NHCAP 的预后因素。本研究旨在通过分析前瞻性数据，探讨 NHCAP 患者 30 天死亡率的相关预后因素。
我们分析了 2010 年 10 月至 2017 年 2 月期间因 NHCAP 住院的患者。年龄、性别、合并症、生命体征和实验室检查结果等被用作预后变量。主要结局为 30 天死亡率。
在 817 例 NHCAP 患者中，平均年龄为 78.0±11.1 岁，580 例（71.0%）为男性，30 天死亡率为 13.1%（107/817）。多因素分析显示，男性（比值比[OR]：2.07，95%置信区间[CI]：1.18-3.63）、恶性肿瘤（OR：2.35，95%CI：1.38-4.01）、表现状态（PS）（OR：1.55，95%CI：1.23-1.96）、体温（OR：0.77，95%CI：0.61-0.97）、心率（OR：1.02，95%CI：1.01-1.03）、呼吸频率（OR：1.04，95%CI：1.01-1.08）、血清白蛋白（Alb）（OR：0.45，95%CI：0.30-0.66）和血尿素氮（BUN）（OR：1.02，95%CI：1.01-1.03）与 30 天死亡率显著相关。另一方面，耐药病原体感染的危险因素预示着更好的预后（OR：0.39，95%CI：0.19-0.82）。
男性、恶性肿瘤、PS 差、低体温、心动过速、呼吸急促、血清 Alb 低和 BUN 高是较差的预后因素。因此，耐药病原体的风险不一定与不良预后相关。
