Department of Neurological Intensive Care Unit, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, Huzhou City, Zhejiang Province, China.
Department of Critical Care Medicine, Huzhou Third Municipal Hospital, the Affiliated Hospital of Huzhou University, 2088 Tiaoxi East Road, Wuxing District, Huzhou City, Zhejiang Province, China.
BMC Pulm Med. 2024 Oct 9;24(1):496. doi: 10.1186/s12890-024-03305-1.
To assess the effect of pneumonia on the risk of mortality and other clinical outcomes in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).
PubMed, EMBASE and Scopus were screened for observational cohort and case-control studies that reported outcomes in AECOPD patients with and without pneumonia. Pooled effect sizes were reported as relative risks (RR) or hazard ratio (HR) for categorical outcomes and as weighted mean difference (WMD) for continuous outcomes. The primary outcome was mortality. Secondary outcomes were risk of admission to intensive care unit (ICU), need for assisted ventilation and readmission as well as duration of stay at the hospital. The certainty of the evidence was assessed using the GRADE approach.
Thirteen studies were included. AECOPD patients with pneumonia had significantly higher risk of in-hospital mortality (RR 2.29, 95% CI: 1.40, 3.73), mortality at 1 month (RR 1.84, 95% CI: 1.09, 3.13), and 1 year or more of follow-up (HR 2.30, 95% CI: 1.15, 4.61) compared to AECOPD patients without pneumonia. Pneumonia was associated with significantly higher risk of admission to ICU (RR 2.79, 95% CI: 1.47, 5.28), need for assisted ventilation (RR 2.02, 95% CI: 1.52, 2.67), and longer hospital stay (in days) (WMD 3.31, 95% CI: 2.33, 4.29). The risk of readmission was comparable in the two groups of patients (RR 1.07, 95% CI: 0.97, 1.19). The overall quality of evidence for the outcomes was judged to be "Low".
Pneumonia during acute exacerbation of COPD may lead to increases in both short-term and long-term mortality as well as increased hospital stay, need for ventilatory support and admission to ICU. Our findings suggest the need for close monitoring, early intervention, and long-term follow-up, to improve the outcomes in AECOPD patients with concurrent pneumonia.
评估肺炎对慢性阻塞性肺疾病急性加重（AECOPD）患者死亡风险和其他临床结局的影响。
在 PubMed、EMBASE 和 Scopus 中筛选了报告 AECOPD 患者合并和不合并肺炎的结局的观察性队列和病例对照研究。分类结局的汇总效应大小以相对风险（RR）或危险比（HR）报告，连续结局以加权均数差（WMD）报告。主要结局为死亡率。次要结局为入住重症监护病房（ICU）的风险、需要辅助通气和再入院以及住院时间。使用 GRADE 方法评估证据的确定性。
纳入了 13 项研究。与不合并肺炎的 AECOPD 患者相比，合并肺炎的 AECOPD 患者住院期间死亡率（RR 2.29，95%CI：1.40，3.73）、1 个月死亡率（RR 1.84，95%CI：1.09，3.13）和 1 年及以上随访死亡率（HR 2.30，95%CI：1.15，4.61）显著更高。肺炎与入住 ICU（RR 2.79，95%CI：1.47，5.28）、需要辅助通气（RR 2.02，95%CI：1.52，2.67）和更长的住院时间（WMD 3.31，95%CI：2.33，4.29）的风险显著增加。两组患者的再入院风险无差异（RR 1.07，95%CI：0.97，1.19）。这些结局的总体证据质量被判定为“低”。
COPD 急性加重期间发生肺炎可能会导致短期和长期死亡率增加，并增加住院时间、需要通气支持和入住 ICU。我们的研究结果表明，需要密切监测、早期干预和长期随访，以改善合并肺炎的 AECOPD 患者的结局。
