Center of Research and Disruption of Infectious Diseases, Department of Infectious Diseases, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
Department of Respiratory Medicine and Infectious Diseases, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark.
Eur Respir J. 2024 Nov 7;64(5). doi: 10.1183/13993003.00054-2024. Print 2024 Nov.
Halm's clinical stability criteria have long guided antibiotic treatment and hospital discharge decisions for patients hospitalised with community-acquired pneumonia (CAP). Originally introduced in 1998, these criteria were established based on a relatively small and select patient population. Consequently, our study aims to reassess their applicability in the management of CAP in a contemporary real-world setting.
This cohort study included 2918 immunocompetent patients hospitalised with CAP from three hospitals in Denmark between 2017 and 2020. The primary outcome was time to achieve clinical stability as defined by Halm's criteria. Additionally, we examined recurrence of clinical instability and severe complications. Cumulative incidence function or Kaplan-Meier survival curves were used to analyse these outcomes, considering competing risks.
The study population primarily comprised elderly individuals (median age 75 years) with significant comorbidities. The median time to clinical stability according to Halm's criteria was 4 days, with one-fifth experiencing recurrence of instability after early clinical response (stability within 3 days). Severe complications within 30 days mainly comprised mortality, with rates of 5.1% (64/1257) overall in those with early clinical response, 1.7% (18/1045) in the subgroup without do-not-resuscitate orders and 17.3% (276/1595) among the rest.
Halm's clinical stability criteria effectively classify CAP patients with different disease courses, yet achieving stability required more time in this ageing population with substantial comorbidities and more severe disease. Early clinical response indicates reduced risk of complications, especially in those without do-not-resuscitate orders.
Halm 的临床稳定标准长期以来一直指导着社区获得性肺炎（CAP）住院患者的抗生素治疗和出院决策。这些标准最初于 1998 年提出，是基于相对较小且选择的患者人群建立的。因此，我们的研究旨在重新评估它们在当代真实世界环境中管理 CAP 的适用性。
这项队列研究纳入了 2017 年至 2020 年期间丹麦三家医院收治的 2918 例免疫功能正常的 CAP 住院患者。主要结局是达到 Halm 标准定义的临床稳定的时间。此外，我们还检查了临床不稳定和严重并发症的复发情况。使用累积发生率函数或 Kaplan-Meier 生存曲线分析这些结局，同时考虑竞争风险。
研究人群主要由老年人（中位年龄 75 岁）组成，伴有显著的合并症。根据 Halm 标准，达到临床稳定的中位时间为 4 天，五分之一的患者在早期临床反应后出现不稳定复发（3 天内稳定）。30 天内的严重并发症主要包括死亡率，在早期临床反应的患者中，总体死亡率为 5.1%（64/1257），无复苏医嘱的亚组中为 1.7%（18/1045），其余患者中为 17.3%（276/1595）。
Halm 的临床稳定标准有效地对具有不同疾病过程的 CAP 患者进行分类，但在这个有大量合并症和更严重疾病的老年人群中，达到稳定需要更多的时间。早期临床反应表明并发症风险降低，特别是在无复苏医嘱的患者中。
