骨折后肺炎风险与脑瘫成人健康和生存结局的关联：一项回顾性队列研究。
Post-fracture pneumonia risk and association with health and survival outcomes for adults with cerebral palsy: A retrospective cohort study.
机构信息
Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
Kidney Epidemiology and Cost Center, School of Public Health, University of Michigan, Ann Arbor, USA.
出版信息
Bone. 2022 Jun;159:116390. doi: 10.1016/j.bone.2022.116390. Epub 2022 Mar 17.
BACKGROUND
For adults with cerebral palsy (CP), fragility fractures may be a risk factor for pneumonia, a leading cause of death for this population; yet, the timing and complications are unknown. The objectives were to determine the 30-day pneumonia rate post-fracture and its association with mortality and incident cardiovascular events among adults with CP.
METHODS
This retrospective cohort study used nationwide administrative claims data from 01/01/2012-12/31/2017 from a random 20% sample of the Medicare fee-for-service and Optum Clinformatics® Data Mart. Cohorts included ≥18 years of age with CP with an incident fragility fracture (CP + Fx) and comparison cohorts: CP without fractures (CPw/oFx) and without CP with an incident fragility fracture (w/oCP + Fx). Incidence rate (IR) of pneumonia 30-days post-fracture and IR ratios were estimated by age group: 18-40, 41-64, and ≥ 65 years. For CP + Fx, Cox regression examined the association between time-varying pneumonia (within 30-days post-fracture) with mortality and incidence of cardiovascular events 0-30-days and 31-365-days post-fracture.
RESULTS
There were 3688 CP + Fx (mean [SD] age, 58.2 [14.9]; 56.4% women), 29,429 CPw/oFx (50.3 [15.8]; 45.9% women), and 363,995 w/oCP + Fx (65.9 [18.3]; 65.5% women). The IR of 30-day pneumonia for CP + Fx was similar across age groups (IR per 100 person-months, 8.4-11.0) and 1.77-16.18-fold higher (all P < 0.05) than comparison cohorts. Peri/post-fracture pneumonia was associated with an increased rate of mortality (30-day-adjusted HR [aHR] = 5.89, 95%CI = 3.54-9.81; 31-365-day aHR = 2.89, 95%CI = 2.13-3.92), congestive heart failure 0-30-days (aHR = 3.64, 95%CI = 2.01-6.57) and 31-365-days (time-dependent), myocardial infarction 31-365-days (aHR = 2.03, 95%CI = 1.11-3.71), and cerebrovascular disease 0-30-days (time-dependent), without evidence of effect modification by age, sex, or fracture site.
CONCLUSIONS
Adults with CP are particularly vulnerable to 30-day risk of post-fracture pneumonia and its complications across the adult lifespan and not just in the elderly years.
背景
对于患有脑瘫（CP）的成年人来说，脆性骨折可能是肺炎的一个风险因素，肺炎是该人群的主要死亡原因；然而，其发病时间和并发症尚不清楚。本研究的目的是确定骨折后 30 天内肺炎的发生率及其与 CP 成年人死亡率和心血管事件发生率的关系。
方法
本回顾性队列研究使用了来自 Medicare 按服务收费和 Optum Clinformatics®Data Mart 的 20%随机样本中 2012 年 1 月 1 日至 2017 年 12 月 31 日期间的全国性行政索赔数据。队列纳入了≥18 岁的伴有脆性骨折的 CP 患者（CP+Fx）和对照队列：无骨折的 CP（CPw/oFx）和无 CP 但伴有脆性骨折的患者（w/oCP+Fx）。通过年龄组（18-40 岁、41-64 岁和≥65 岁）估计骨折后 30 天内肺炎的发生率（IR）和 IR 比值。对于 CP+Fx，Cox 回归分析了骨折后 30 天内肺炎（时间依赖性）与骨折后 0-30 天和 31-365 天内死亡率和心血管事件发生率之间的关系。
结果
CP+Fx 组共 3688 例（平均[标准差]年龄 58.2[14.9]岁，56.4%为女性），CPw/oFx 组 29429 例（50.3[15.8]岁，45.9%为女性），w/oCP+Fx 组 363995 例（65.9[18.3]岁，65.5%为女性）。CP+Fx 组的 30 天肺炎发生率在各年龄组间相似（每 100 人-月的发生率为 8.4-11.0），与对照队列相比，其比值比为 1.77-16.18 倍（均 P<0.05）。骨折后和围手术期肺炎与死亡率增加相关（30 天校正 HR[aHR]为 5.89，95%CI 为 3.54-9.81；31-365 天 aHR 为 2.89，95%CI 为 2.13-3.92），30 天内充血性心力衰竭（aHR 为 3.64，95%CI 为 2.01-6.57）和 31-365 天内（时间依赖性）、心肌梗死 31-365 天内（aHR 为 2.03，95%CI 为 1.11-3.71）和 30 天内脑血管疾病（时间依赖性），且无年龄、性别或骨折部位的效应修饰作用。
结论
CP 成年人在整个成年期，而不仅仅是在老年期，骨折后 30 天内发生肺炎及其并发症的风险特别高。
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