Unit of Pneumology Service, Hospital Universitario Cruces, Barakaldo, Spain.
Bioinformatics and Statistics Unit, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain.
Infect Dis (Lond). 2020 Sep;52(9):603-611. doi: 10.1080/23744235.2020.1772991. Epub 2020 Jun 19.
Nowadays, most cases of pneumococcal community-acquired pneumonia (PCAP) are diagnosed by positive urinary antigen. Our aims were to analyse process of care in patients hospitalised with non-bacteremic PCAP (NB-PCAP) and identify factors associated with poor outcome (PO) in this population. We conducted a prospective study, including patients hospitalised for NB-PCAP (positive urinary antigen and negative blood culture) over a 15 year period. We performed multivariate analysis of predisposing factors for PO, defined as need for mechanical ventilation and/or shock and/or in-hospital death. Of the 638 patients included, 4.1% died in hospital and 12.8% had PO. Host-related factors were similar in patients with and without PO, but patients with PO had higher illness severity on admission. Adjusted analysis revealed the following independent factors associated with PO: being a nursing home resident (OR: 6.156; 95% CI: 1.827-20.750; = .003), respiratory rate ≥30 breaths/min (OR: 3.030; 95% CI: 1.554-5.910; = .001), systolic blood pressure <90 mmHg (OR: 4.789; 95% CI: 1.967-11.660; = .001), diastolic blood pressure <60 mmHg (OR: 2.820; 95% CI: 1.329-5.986; = .007), pulse rate ≥125 beats/min (OR: 3.476; 95% CI: 1.607-7.518; = .002), pH <7.35 (OR: 9.323; 95% CI: 3.680-23.622; < .001), leukocytes <4000/µL (OR: 10.007; 95% CI: 2.960-33.835; < .001), and severe inflammation (OR: 2.364; 95% CI 1.234-4.526; = .009). The area under the curve for predicting PO was 0.890 (95% CI: 0.851-0.929). Since patients with PO seem different and had worse in-hospital course, we identified eight independent risk factors for PO measurable on admission.
如今，大多数社区获得性肺炎（CAP）病例通过尿抗原检测阳性来诊断。我们的目的是分析非菌血症性 CAP（NB-CAP）住院患者的治疗过程，并确定该人群中预后不良（PO）的相关因素。我们进行了一项前瞻性研究，纳入了 15 年来因 NB-CAP（尿抗原阳性且血培养阴性）住院的患者。我们对 PO 的相关因素进行了多变量分析，PO 定义为需要机械通气和/或休克和/或院内死亡。在纳入的 638 例患者中，4.1%的患者死亡，12.8%的患者发生 PO。有 PO 和无 PO 患者的宿主相关因素相似，但 PO 患者入院时疾病严重程度更高。调整分析显示，以下独立因素与 PO 相关：居住在护理院（OR：6.156；95%CI：1.827-20.750； = .003）、呼吸频率≥30 次/分（OR：3.030；95%CI：1.554-5.910； = .001）、收缩压<90mmHg（OR：4.789；95%CI：1.967-11.660； = .001）、舒张压<60mmHg（OR：2.820；95%CI：1.329-5.986； = .007）、脉搏率≥125 次/分（OR：3.476；95%CI：1.607-7.518； = .002）、pH 值<7.35（OR：9.323；95%CI：3.680-23.622； < .001）、白细胞计数<4000/μL（OR：10.007；95%CI：2.960-33.835； < .001）和严重炎症（OR：2.364；95%CI 1.234-4.526； = .009）。预测 PO 的曲线下面积为 0.890（95%CI：0.851-0.929）。由于 PO 患者似乎不同且住院期间病情更差，我们确定了 8 个入院时可测量的 PO 独立风险因素。
