Division of Respiratory Medicine, Department of Integrated Traditional and Western Medicine, West China School of Medicine, Sichuan University, Chengdu, China.
Division of Respiratory Medicine, Department of Integrated Traditional and Western Medicine, West China Hospital, Sichuan University, Chengdu, China.
Respiration. 2021;100(1):64-76. doi: 10.1159/000510615. Epub 2021 Jan 15.
Patients with chronic obstructive pulmonary disease (COPD) are at a heightened risk of pneumonia. Whether coexisting community-acquired pneumonia (CAP) can predict increased mortality in hospitalized COPD patients is still controversial.
This systematic review and meta-analysis aims to assess the association between CAP and mortality and morbidity in COPD patients hospitalized for acute worsening of respiratory symptoms.
In this review, cohort studies and case-control studies investigating the impact of CAP in hospitalized COPD patients were retrieved from 4 electronic databases from inception until December 2019. Methodological quality of included studies was assessed using Newcastle-Ottawa Quality Assessment Scale. The primary outcome was mortality. The secondary outcomes included length of hospital stay, need for mechanical ventilation, intensive care unit (ICU) admission, length of ICU stay, and readmission rate. The Mantel-Haenszel method and inverse variance method were used to calculate pooled relative risk (RR) and mean difference (MD), respectively.
A total of 18 studies were included. The presence of CAP was associated with higher mortality (RR = 1.85; 95% CI: 1.50-2.30; p < 0.00001), longer length of hospital stay (MD = 1.89; 95% CI: 1.19-2.59; p < 0.00001), more need for mechanical ventilation (RR = 1.48; 95% CI: 1.32-1.67; p < 0.00001), and more ICU admissions (RR = 1.58; 95% CI: 1.24-2.03; p = 0.0002) in hospitalized COPD patients. CAP was not associated with longer ICU stay (MD = 5.2; 95% CI: -2.35 to 12.74; p = 0.18) or higher readmission rate (RR = 1.02; 95% CI: 0.96-1.09; p = 0.47).
Coexisting CAP may be associated with increased mortality and morbidity in hospitalized COPD patients, so radiological confirmation of CAP should be required and more attention should be paid to these patients.
慢性阻塞性肺疾病（COPD）患者发生肺炎的风险较高。合并社区获得性肺炎（CAP）是否会增加住院 COPD 患者的死亡率仍存在争议。
本系统评价和荟萃分析旨在评估 CAP 与因呼吸症状急性恶化而住院的 COPD 患者的死亡率和发病率之间的关系。
本综述中，从 4 个电子数据库中检索了从创建到 2019 年 12 月调查 CAP 对住院 COPD 患者影响的队列研究和病例对照研究。使用纽卡斯尔-渥太华质量评估量表评估纳入研究的方法学质量。主要结局是死亡率。次要结局包括住院时间、机械通气需求、重症监护病房（ICU）入住、ICU 住院时间和再入院率。使用 Mantel-Haenszel 法和Inverse Variance 法分别计算合并相对风险（RR）和平均差（MD）。
共纳入 18 项研究。CAP 的存在与更高的死亡率（RR=1.85；95%CI：1.50-2.30；p<0.00001）、更长的住院时间（MD=1.89；95%CI：1.19-2.59；p<0.00001）、更多的机械通气需求（RR=1.48；95%CI：1.32-1.67；p<0.00001）和更多的 ICU 入住（RR=1.58；95%CI：1.24-2.03；p=0.0002）相关。CAP 与 ICU 住院时间延长（MD=5.2；95%CI：-2.35 至 12.74；p=0.18）或再入院率升高（RR=1.02；95%CI：0.96-1.09；p=0.47）无关。
合并 CAP 可能与住院 COPD 患者的死亡率和发病率增加相关，因此应要求对 CAP 进行影像学确认，并应更加关注这些患者。
