Crisafulli Ernesto, Cillóniz Catia, Liapikou Adamantia, Ferrari Marcello, Busti Fabiana, Girelli Domenico, Torres Antoni
Department of Medicine, Respiratory Medicine Unit, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, 37134 Verona, Italy.
Department of Medicine, Section of Internal Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, 37134 Verona, Italy.
J Clin Med. 2020 Sep 7;9(9):2884. doi: 10.3390/jcm9092884.
The systemic inflammatory response (SIR) may help to predict clinical progression, treatment failure, and prognosis in community-acquired pneumonia (CAP). Exposure to tobacco smoke may affect the SIR; the role of smoking in CAP has not been consolidated. We evaluated the SIR and outcomes of hospitalized CAP patients stratified by smoking habits and the presence of COPD. This retrospective analysis was conducted at the Hospital Clinic of Barcelona. Baseline, clinical, microbiological, and laboratory variables were collected at admission, using C-reactive protein (CRP) levels as a marker of SIR. The study outcomes were pleural complications, hospital stay, non-invasive and invasive mechanical ventilation (IMV), and intensive care unit (ICU) admission. We also considered the in-hospital and 30-day mortality. Data were grouped by smoking habit (non-, former-, and current-smokers) and the presence of COPD. Current smokers were younger, had fewer comorbidities, and fewer previous pneumonia episodes. CRP levels were higher in current smokers than in other groups. Current smokers had a higher risk of pleural complications independent of CRP levels, the presence of pleuritic pain, and a higher platelet count. Current smokers more often required IMV and ICU admission. Current smokers have a greater inflammatory response and are at increased risk of pleural complications.
全身炎症反应（SIR）可能有助于预测社区获得性肺炎（CAP）的临床进展、治疗失败及预后。接触烟草烟雾可能会影响SIR；吸烟在CAP中的作用尚未明确。我们评估了按吸烟习惯和慢性阻塞性肺疾病（COPD）情况分层的住院CAP患者的SIR及预后。这项回顾性分析在巴塞罗那医院诊所进行。入院时收集基线、临床、微生物学和实验室变量，使用C反应蛋白（CRP）水平作为SIR的标志物。研究结局包括胸膜并发症、住院时间、无创和有创机械通气（IMV）以及重症监护病房（ICU）入住情况。我们还考虑了院内及30天死亡率。数据按吸烟习惯（从不吸烟者、既往吸烟者和当前吸烟者）和COPD情况分组。当前吸烟者更年轻，合并症更少，既往肺炎发作次数也更少。当前吸烟者的CRP水平高于其他组。无论CRP水平、胸膜炎性疼痛的存在情况及血小板计数较高与否，当前吸烟者发生胸膜并发症的风险更高。当前吸烟者更常需要IMV及入住ICU。当前吸烟者有更强的炎症反应且发生胸膜并发症的风险增加。
