National Infectious Diseases Service, Specialty Care Services, Veterans Health Administration, US Department of Veterans Affairs, Washington, District of Columbia, United States of America.
Division of Infectious Diseases, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America.
PLoS One. 2021 Jan 11;16(1):e0245262. doi: 10.1371/journal.pone.0245262. eCollection 2021.
Research on Legionnaires' Disease (LD) suggests there may be long-term health complications, but data are limited. This study investigated whether Intensive Care Unit (ICU) admission during LD hospitalization may be associated with adverse health outcomes and characterized subsequent discharge diagnoses in patients with LD up to 5 years post-LD.
We conducted a retrospective case series study with follow up for 5 years among patients hospitalized at a Department of Veterans Affairs (VA) Medical Center between 2005 and 2010 with LD. Data were collected from medical records on health history, LD severity (including ICU admission), and discharge diagnoses for 5 years post-LD or until death. We used ordinal logistic regression to explore associations between ICU admission and hospitalizations post-LD. Frequency counts were used to determine the most prevalent discharge diagnoses in the 5 years post-LD.
For the 292 patients with laboratory-confirmed LD, those admitted to the ICU during LD hospitalization were more likely to have a greater number of hospitalizations within 5 years compared to non-ICU patients (ORHosp 1.92 CI95% 1.25, 2.95). Fifty-five percent (161/292) had ≥ 1 hospitalization within 5 years post-LD. After accounting for pre-existing diagnosis codes in patients with at least one hospitalization in the 2 years prior to LD (n = 77/161 patients, 47.8%), three of the four most frequent new diagnoses in the 5 years post-LD were non-chronic conditions: acute renal failure (n = 22, 28.6%), acute respiratory failure (n = 17, 22.1%) and unspecified pneumonia (n = 15, 19.5%).
Our findings indicate that LD requiring ICU admission is associated with more subsequent hospitalizations, a factor that could contribute to poorer future health for people with severe LD. In addition to chronic conditions prevalent in this study population, we found new diagnoses in the 5-year post-LD period including acute renal failure. With LD incidence increasing, more research is needed to understand conditions and factors that influence long term health after LD.
军团病（LD）的研究表明，可能存在长期健康并发症，但数据有限。本研究调查了 LD 住院期间入住重症监护病房（ICU）是否与不良健康结局相关，并描述了 LD 后 5 年内 LD 患者的出院诊断。
我们对 2005 年至 2010 年间在退伍军人事务部（VA）医疗中心住院的 LD 患者进行了回顾性病例系列研究，随访时间为 5 年。从病历中收集健康史、LD 严重程度（包括 ICU 入院）和 LD 后 5 年或直至死亡的出院诊断数据。我们使用有序逻辑回归来探讨 ICU 入院与 LD 后住院的关系。频率计数用于确定 LD 后 5 年内最常见的出院诊断。
在 292 例实验室确诊 LD 患者中，与非 ICU 患者相比，LD 住院期间入住 ICU 的患者在 5 年内更有可能多次住院（ORHosp 1.92 CI95% 1.25, 2.95）。55%（161/292）在 LD 后 5 年内至少有 1 次住院。在考虑到 LD 前 2 年内至少有 1 次住院的患者的预先存在的诊断代码（n = 77/161 例，47.8%）后，LD 后 5 年内的四个最常见的新诊断中有三个是非慢性疾病：急性肾衰竭（n = 22，28.6%）、急性呼吸衰竭（n = 17，22.1%）和未特指肺炎（n = 15，19.5%）。
我们的研究结果表明，需要 ICU 入院的 LD 与更多随后的住院有关，这可能是导致严重 LD 患者未来健康状况较差的一个因素。除了本研究人群中常见的慢性疾病外，我们还在 LD 后 5 年期间发现了新的诊断，包括急性肾衰竭。随着 LD 发病率的增加，需要更多的研究来了解影响 LD 后长期健康的条件和因素。
