2012 - 2019年孟加拉国重症急性呼吸道感染住院患者出院后死亡率：一项前瞻性观察研究
Post-discharge mortality among patients hospitalised with severe acute respiratory infection, Bangladesh, 2012-2019: a prospective observational study.
作者信息
Islam Md Ariful, Hassan Md Zakiul, Aleem Mohammad Abdul, Akhtar Zubair, Chowdhury Sukanta, Ahmmed Md Kaousar, Rahman Mustafizur, Rahman Mohammed Ziaur, Mah-E-Muneer Syeda, Uzzaman M Salim, Shirin Tahmina, Flora Meerjady Sabrina, Rahman Mahmudur, Davis William W, Azziz-Baumgartner Eduardo, Iuliano A Danielle, Chowdhury Fahmida
机构信息
International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh.
出版信息
Lancet Reg Health Southeast Asia. 2024 Feb 29;25:100363. doi: 10.1016/j.lansea.2024.100363. eCollection 2024 Jun.
BACKGROUND
Enhancing outcomes post-hospitalisation requires an understanding of predictive factors for adverse events. This study aimed to estimate post-discharge mortality rates among patients with severe acute respiratory infection (SARI) in Bangladesh, identify associated factors, and document reported causes of death.
METHODS
From January 2012 to December 2019, we conducted follow-up calls to patients or their families 30 days after discharge to assess the status of patients with SARI. Proportions of deaths within 30 days of discharge were estimated, and a comparative analysis of demographics, clinical characteristics, and influenza illness between decedents and survivors was performed using multivariable Cox regression models.
FINDINGS
Among 23,360 patients with SARI (median age: 20 years, IQR: 1.5-48, 65% male), 351 (1.5%) died during hospitalisation. Of 23,009 patients alive at discharge, 20,044 (87%) were followed, with 633 (3.2%) deaths within 30 days of discharge. In children (<18 years), difficulty breathing (adjusted hazard ratio [aHR] 1.8; 95% CI 1.1-3.0), longer hospital stay (aHR 1.1; 95% CI 1.1-1.1), and heart diseases (aHR 8.5; 95% CI 3.2-23.1) were associated with higher post-discharge death risk. Among adults (≥18 years), difficulty breathing (aHR 2.3; 95% CI 1.7-3.0), chronic obstructive pulmonary disease (aHR 1.7; 95% CI 1.4-2.2), and intensive care unit admission (aHR 5.2; 95% CI 1.9-14.0) were linked to elevated post-discharge death risk. Influenza virus was detected in 13% (46/351) of in-hospital SARI deaths and 10% (65/633) of post-discharge SARI deaths.
INTERPRETATION
Nearly one in twenty patients with SARI died during hospitalisation or within 1 month of discharge, with two-thirds of deaths occurring post-discharge. Seasonal influenza vaccination is recommended to mitigate influenza-associated mortality. To enhance post-discharge outcomes, hospitals should consider developing safe-discharge algorithms, reinforcing post-discharge care plans, and establishing outpatient monitoring for recently discharged patients.
FUNDING
Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA [U01GH002259].
背景
改善住院后的治疗效果需要了解不良事件的预测因素。本研究旨在估计孟加拉国严重急性呼吸道感染（SARI）患者出院后的死亡率，确定相关因素，并记录报告的死亡原因。
方法
2012年1月至2019年12月，我们在患者出院30天后对患者或其家属进行随访电话，以评估SARI患者的状况。估计出院后30天内的死亡比例，并使用多变量Cox回归模型对死者和幸存者的人口统计学、临床特征和流感疾病进行比较分析。
结果
在23360例SARI患者中（中位年龄：20岁，IQR：1.5 - 48，65%为男性），351例（1.5%）在住院期间死亡。在出院时存活的23009例患者中，20044例（87%）接受了随访，其中633例（3.2%）在出院后30天内死亡。在儿童（<18岁）中，呼吸困难（调整后风险比[aHR] 1.8；95% CI 1.1 - 3.0）、住院时间延长（aHR 1.1；95% CI 1.1 - 1.1）和心脏病（aHR 8.5；95% CI 3.2 - 23.1）与出院后死亡风险较高相关。在成年人（≥18岁）中，呼吸困难（aHR 2.3；95% CI 1.7 - 3.0）、慢性阻塞性肺疾病（aHR 1.7；95% CI 1.4 - 2.2）和入住重症监护病房（aHR 5.2；95% CI 1.9 - 14.0）与出院后死亡风险升高有关。在住院期间SARI死亡病例中，13%（46/351）检测到流感病毒，出院后SARI死亡病例中，10%（65/633）检测到流感病毒。
解读
近二十分之一的SARI患者在住院期间或出院后1个月内死亡，三分之二的死亡发生在出院后。建议进行季节性流感疫苗接种以降低流感相关死亡率。为了改善出院后的治疗效果，医院应考虑制定安全出院算法，加强出院后护理计划，并为近期出院患者建立门诊监测。
资助
美国佐治亚州亚特兰大疾病控制与预防中心（CDC）[U01GH002259]
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