Department of Surgery, Duke University, Durham, NC, USA.
Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA.
J Intensive Care Med. 2024 Oct;39(10):994-1001. doi: 10.1177/08850666241248568. Epub 2024 Apr 25.
To identify risk factors for and outcomes in acute respiratory distress syndrome (ARDS) in patients hospitalized with community-acquired pneumonia (CAP). This is a retrospective study using the Premier Healthcare Database between 2016 and 2020. Patients diagnosed with pneumonia, requiring mechanical ventilation (MV), antimicrobial therapy, and hospital admission ≥2 days were included. Multivariable regression models were used for outcomes including in-hospital mortality, hospital length of stay (LOS), intensive care unit (ICU) LOS, and days on MV. 1924 (2.7%) of 72 107 patients with CAP developed ARDS. ARDS was associated with higher mortality (33.7% vs 18.9%; adjusted odds ratio 2.4; 95% confidence interval [CI] 2.16-2.66), longer hospital LOS (13 vs 9 days; adjusted incidence risk ratio (aIRR) 1.24; 95% CI 1.20-1.27), ICU LOS (9 vs 5 days; aIRR 1.51; 95% CI 1.46-1.56), more MV days (8 vs 5; aIRR 1.54; 95% CI 1.48-1.59), and increased hospitalization cost ($46 459 vs $29 441; aIRR 1.50; 95% CI 1.45-1.55). In CAP, ARDS was associated with worse in-patient outcomes in terms of mortality, LOS, and hospitalization cost. Future studies are needed to explore outcomes in patients with CAP with ARDS and explore risk factors for development of ARDS after CAP.
为了确定患有社区获得性肺炎（CAP）的住院患者中急性呼吸窘迫综合征（ARDS）的风险因素和结局。这是一项使用 Premier Healthcare Database 进行的回顾性研究，时间范围为 2016 年至 2020 年。纳入的患者诊断为肺炎，需要机械通气（MV）、抗菌治疗和住院≥2 天。使用多变量回归模型评估了包括院内死亡率、住院时间（LOS）、重症监护病房（ICU） LOS 和 MV 使用天数在内的结局。在 72107 例 CAP 患者中，有 1924 例（2.7%）发展为 ARDS。ARDS 与更高的死亡率（33.7% vs. 18.9%；调整后优势比 2.4；95%置信区间 [CI] 2.16-2.66）、更长的住院 LOS（13 天 vs. 9 天；调整后的发病率风险比 [aIRR] 1.24；95% CI 1.20-1.27）、更长的 ICU LOS（9 天 vs. 5 天；aIRR 1.51；95% CI 1.46-1.56）、更多的 MV 天数（8 天 vs. 5 天；aIRR 1.54；95% CI 1.48-1.59）和更高的住院费用（$46459 比 $29441；aIRR 1.50；95% CI 1.45-1.55）相关。在 CAP 中，ARDS 与死亡率、LOS 和住院费用方面的住院患者结局恶化相关。需要进一步研究以探讨 CAP 合并 ARDS 患者的结局，并探讨 CAP 后 ARDS 发展的风险因素。
