Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Saitama, Japan.
Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Saitama, Japan.
Respir Med. 2021 Jan;176:106279. doi: 10.1016/j.rmed.2020.106279. Epub 2020 Dec 6.
Some studies have reported that long-term prognosis after pneumonia is poor. Our aim was to determine predictors of long-term outcomes with special attention to community-acquired pneumonia (CAP) etiology.
We studied 1930 patients who were hospitalized with CAP from January 2002 through November 2017 at Saitama Cardiovascular and Respiratory Center and were discharged alive. We conducted a retrospective study for calculation of survival rate using the Kaplan-Meier method and analysis of prognostic factors by multivariate analysis using a Cox proportional hazard model.
The median follow-up period was 442.5 (range 1-5514) days. During this period, 321 patients died. Median survival time was 11.9 years, and 1-year and 5-year survival rates were 93.8% and 74.0%, respectively. Among the patients' demographics factors, old age, poor performance status (PS) score, pneumococcal vaccination history, some underlying respiratory diseases, and chronic heart failure were significant independent factors of poor prognosis. Among pathogens, Streptococcus pneumoniae (hazard ratio [HR]: 1.35, 95% confidence interval [CI]: 1.03, 3.07, P = 0.038) and Pseudomonas aeruginosa (HR: 1.68, 95% CI: 1.07, 2.64, P = 0.024) were significant independent factors of poor prognosis, whereas influenza virus tended to predict a good prognosis (HR: 0.60, 95% CI: 0.36, 1.02, P = 0.058). Respiratory disease accounted for 59% of all causes of death after CAP, and the rate of death from pneumonia was the largest at 22%.
Not only age, general condition, and comorbidities but also specific pathogens were predictors of long-term prognosis after hospital discharge for CAP.
一些研究报告指出，肺炎的长期预后较差。我们的目的是确定长期预后的预测因素，特别关注社区获得性肺炎（CAP）的病因。
我们研究了 1930 名于 2002 年 1 月至 2017 年 11 月在埼玉心血管呼吸中心因 CAP 住院并存活出院的患者。我们采用 Kaplan-Meier 法计算生存率，采用 Cox 比例风险模型进行多因素分析，分析预后因素。
中位随访时间为 442.5（范围 1-5514）天。在此期间，321 名患者死亡。中位生存时间为 11.9 年，1 年和 5 年生存率分别为 93.8%和 74.0%。在患者的人口统计学因素中，年龄较大、一般状况较差（PS 评分）、肺炎球菌疫苗接种史、某些基础呼吸系统疾病和慢性心力衰竭是预后不良的显著独立因素。在病原体中，肺炎链球菌（HR：1.35，95%置信区间[CI]：1.03，3.07，P=0.038）和铜绿假单胞菌（HR：1.68，95% CI：1.07，2.64，P=0.024）是预后不良的显著独立因素，而流感病毒则倾向于预测较好的预后（HR：0.60，95% CI：0.36，1.02，P=0.058）。CAP 后所有死因中，呼吸系统疾病占 59%，肺炎死亡率最高，为 22%。
不仅年龄、一般状况和合并症，而且特定病原体也是 CAP 出院后长期预后的预测因素。
