Oi Issei, Ito Isao, Tanabe Naoya, Konishi Satoshi, Ibi Yumiko, Hidaka Yu, Hamao Nobuyoshi, Shirata Masahiro, Nishioka Kensuke, Imai Seiichiro, Yasutomo Yoshiro, Kadowaki Seizo, Hirai Toyohiro
Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan.
Department of Internal Medicine, Ono Municipal Hospital, Ono, Hyogo, Japan.
Eur Clin Respir J. 2024 Apr 4;11(1):2335721. doi: 10.1080/20018525.2024.2335721. eCollection 2024.
It is known that the mortality of pneumonia in patients with risk factors for aspiration is worse than that in those without these risk factors. However, it is still unknown which risk factors for aspiration predict prognosis. Therefore, we aimed to determine which risk factors for aspiration are associated with death or prolonged hospitalization.
We prospectively followed patients with community-acquired pneumonia at a single hospital providing acute to chronic care in Japan until they died or were discharged. Patients at any risk of aspiration were included. The associations between pneumonia severity, individual risk factors for aspiration, and in-hospital death or prolonged hospitalization were investigated. Overall survival was estimated by the Kaplan - Meier method, and the factors associated with in-hospital death or prolonged hospitalization were investigated by multivariate analysis using factors selected by a stepwise method.
In total, 765 patients with pneumonia and risk factors for aspiration were recruited. One hundred and ten patients deceased, and 259 patients were hospitalized over 27 days. In-hospital death increased as the number of risk factors for aspiration increased. In the multivariate analysis, male, impaired consciousness, acidemia, elevated blood urea nitrogen, and bedridden status before the onset of pneumonia were associated with in-hospital death (odds ratio [OR]: 2.5, 2.5, 3.6, 3.1, and 2.6; 95% confidence interval [CI]: 1.6-4.1, 1.4-4.2, 1.6-8.0, 1.9-5.0, and 1.6-4.2 respectively). In the Cox regression analysis, these factors were also associated with in-hospital death. None of the vital signs at admission were associated. Tachycardia, elevated blood urea nitrogen, hyponatremia, and bedridden status were associated with hospitalization for >27 days (OR: 4.1, 2.3, 4.3, and 2.9; 95% CI: 1.3-12.9, 1.5-3.4, 2.0-9.4, and 2.0-4.0, respectively).
Blood sampling findings and bedridden status are useful for predicting in-hospital mortality and long-term hospitalization in patients with pneumonia and any risk factor for aspiration.
已知存在误吸风险因素的肺炎患者的死亡率高于无这些风险因素的患者。然而，仍不清楚哪些误吸风险因素可预测预后。因此，我们旨在确定哪些误吸风险因素与死亡或延长住院时间相关。
我们对日本一家提供急性至慢性护理的单一医院的社区获得性肺炎患者进行前瞻性随访，直至他们死亡或出院。纳入任何有误吸风险的患者。研究肺炎严重程度、个体误吸风险因素与院内死亡或延长住院时间之间的关联。采用Kaplan-Meier法估计总生存率，并使用逐步法选择的因素通过多变量分析研究与院内死亡或延长住院时间相关的因素。
总共招募了765例患有肺炎且有误吸风险因素的患者。110例患者死亡，259例患者住院超过27天。院内死亡随着误吸风险因素数量的增加而增加。在多变量分析中，男性、意识障碍、酸血症、血尿素氮升高以及肺炎发作前的卧床状态与院内死亡相关（比值比[OR]：2.5、2.5、3.6、3.1和2.6；95%置信区间[CI]：分别为1.6 - 4.1、1.4 - 4.2、1.6 - 8.0、1.9 - 5.0和1.6 - 4.2）。在Cox回归分析中，这些因素也与院内死亡相关。入院时的生命体征均无关联。心动过速、血尿素氮升高、低钠血症和卧床状态与住院超过27天相关（OR：4.1、2.3、4.3和2.9；95%CI：分别为1.3 - 12.9、1.5 - 3.4、2.0 - 9.4和2.0 - 4.0）。
血液检查结果和卧床状态有助于预测患有肺炎且有任何误吸风险因素的患者的院内死亡率和长期住院情况。
