美国社区获得性肺炎需入住重症监护病房的负担
The Burden of Community-Acquired Pneumonia Requiring Admission to ICU in the United States.
作者信息
Cavallazzi Rodrigo, Furmanek Stephen, Arnold Forest W, Beavin Leslie A, Wunderink Richard G, Niederman Michael S, Ramirez Julio A
机构信息
Divisions of Pulmonary, Critical Care Medicine, and Sleep Disorders, University of Louisville, Louisville, KY.
Divisions of Infectious Diseases, University of Louisville, Louisville, KY.
出版信息
Chest. 2020 Sep;158(3):1008-1016. doi: 10.1016/j.chest.2020.03.051. Epub 2020 Apr 13.
BACKGROUND
A paucity of studies have assessed the epidemiology of community-acquired pneumonia (CAP) that require ICU admission. We conducted a study on this group of patients with the primary objective of defining the incidence, epidemiology, and mortality rate of CAP in the ICUs in Louisville, Kentucky. The secondary objective was to estimate the number of patients who were hospitalized and the number of deaths that were associated with CAP in ICU in the United States.
RESEARCH QUESTIONS
What is epidemiology of CAP in the ICU in Louisville, Kentucky, and the projected incidence in the United States?
STUDY DESIGN AND METHODS
This was a secondary analysis of a prospective population-based cohort study. The setting was all nine adult hospitals in Louisville, Kentucky. The annual incidence of CAP in the ICU per 100,000 adults was calculated for the whole adult population of Louisville. The number of patients who were hospitalized because of CAP in ICU in the United States was estimated by multiplying the Louisville incidence rate of CAP in ICU by the 2014 US adult population.
RESULTS
From a total of 7,449 unique patients who were hospitalized with CAP, 1,707 patients (23%) were admitted to the ICU. The incidence of CAP in the ICU was 145 cases per 100,000 population of adults. Cases of CAP in the ICU were clustered in patients from areas of the city with high poverty. The mortality rate of patients with CAP in ICU was 27% at 30 days and 47% at one year. In the United States, the estimated number of patients who were hospitalized with CAP requiring the ICU was 356,326 per year, and the estimated number of deaths at 30 days and one year were 96,206 and 167,474, respectively.
INTERPRETATION
Almost one in five patients who are hospitalized with CAP requires intensive care. Poverty is associated with CAP in the ICU. Nearly one-half of patients with CAP in the ICU will die within one year. Because of its significant burden, CAP in the ICU should be a high priority in research agenda and health policy.
背景
评估需要入住重症监护病房（ICU）的社区获得性肺炎（CAP）的流行病学的研究较少。我们针对这组患者开展了一项研究，主要目的是确定肯塔基州路易斯维尔市各ICU中CAP的发病率、流行病学特征和死亡率。次要目的是估算美国因CAP入住ICU的住院患者数量以及相关死亡人数。
研究问题
肯塔基州路易斯维尔市各ICU中CAP的流行病学特征是什么，以及美国的预计发病率是多少？
研究设计与方法
这是一项基于前瞻性人群队列研究的二次分析。研究地点为肯塔基州路易斯维尔市的所有九家成人医院。计算路易斯维尔市全体成年人口中每10万名成年人的ICU中CAP年发病率。通过将路易斯维尔市ICU中CAP发病率乘以2014年美国成年人口数来估算美国因CAP入住ICU的住院患者数量。
结果
在总共7449例因CAP住院的不同患者中，1707例（23%）入住了ICU。ICU中CAP的发病率为每10万成年人口145例。ICU中CAP病例集中在该市贫困率高的地区的患者中。ICU中CAP患者的30天死亡率为27%，一年死亡率为47%。在美国，估计每年因CAP需要入住ICU的住院患者数量为356326例，30天和一年的估计死亡人数分别为96206例和167474例。
解读
几乎五分之一因CAP住院的患者需要重症监护。贫困与ICU中的CAP相关。ICU中近一半的CAP患者将在一年内死亡。由于其负担沉重，ICU中的CAP应成为研究议程和卫生政策的高度优先事项。
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