Sharma Yogesh, Mangoni Arduino A, Horwood Chris, Thompson Campbell
Department of Acute and General Medicine, Flinders Medical Centre, Adelaide 5042, Australia.
College of Medicine & Public Health, Flinders University, Adelaide 5042, Australia.
Nutrients. 2024 Nov 23;16(23):4009. doi: 10.3390/nu16234009.
BACKGROUND/OBJECTIVES: Community-acquired pneumonia (CAP) is a leading cause of hospitalisations worldwide. Micronutrient deficiencies may influence CAP risk and severity, but their impact on CAP outcomes remains unclear. This study investigated the influence of multivitamin use on hospital length of stay (LOS), intensive care unit (ICU) admission, in-hospital mortality, and 30-day readmissions in hospitalised CAP patients.
This retrospective cohort study included all CAP admissions, identified using ICD-10-AM codes, at two tertiary hospitals in Australia between 2018 and 2023. Pneumonia severity was determined using the CURB65 score, while frailty and nutritional status were assessed using the Hospital Frailty Risk Score (HFRS) and the Malnutrition Universal Screening Tool (MUST). Multivitamin use at admission was identified through the hospital pharmacy database. Propensity score matching (PSM) controlled for 22 confounders and the average treatment effect on the treated (ATET) was determined to evaluate clinical outcomes.
The mean (SD) age of the 8162 CAP cases was 75.3 (17.5) years, with 54.7% males. The mean (SD) CURB65 score was 1.9 (1.0), with 29.2% having severe CAP (CURB65 ≥ 3). On admission, 563 patients (6.9%) were on multivitamin supplements. Multivitamin users were younger, had more comorbidities, higher frailty, and higher socioeconomic status than non-users ( < 0.05). The ATET analysis found no significant differences in LOS (aOR 0.14, 95% CI 0.03-5.98, = 0.307), in-hospital mortality (aOR 1.04, 95% CI 0.97-1.11, = 0.239), or other outcomes.
Multivitamin use was documented in 6.9% of CAP patients and was associated with multimorbidity and frailty but not with improved clinical outcomes. Further research is needed to determine if specific vitamin supplements may offer benefits in this population.
背景/目的：社区获得性肺炎（CAP）是全球住院治疗的主要原因。微量营养素缺乏可能会影响CAP的风险和严重程度，但其对CAP结局的影响仍不明确。本研究调查了服用多种维生素对住院CAP患者的住院时间（LOS）、重症监护病房（ICU）入住率、院内死亡率和30天再入院率的影响。
这项回顾性队列研究纳入了2018年至2023年期间澳大利亚两家三级医院所有使用ICD-10-AM编码确定的CAP入院病例。使用CURB65评分确定肺炎严重程度，同时使用医院衰弱风险评分（HFRS）和营养不良通用筛查工具（MUST）评估衰弱和营养状况。通过医院药房数据库确定入院时使用多种维生素的情况。倾向评分匹配（PSM）控制了22个混杂因素，并确定了治疗组的平均治疗效果（ATET）以评估临床结局。
8162例CAP病例的平均（标准差）年龄为75.3（17.5）岁，男性占54.7%。平均（标准差）CURB65评分为1.9（1.0），29.2%的患者患有重症CAP（CURB65≥3）。入院时，563例患者（6.9%）正在服用多种维生素补充剂。与未使用者相比，服用多种维生素的患者更年轻，合并症更多，衰弱程度更高，社会经济地位更高（P<0.05）。ATET分析发现，住院时间（调整优势比[aOR]0.14，95%置信区间[CI]0.03-5.98，P=0.307）、院内死亡率（aOR 1.04，95%CI 0.97-1.11，P=0.239）或其他结局方面无显著差异。
6.9%的CAP患者记录了使用多种维生素的情况，这与多种合并症和衰弱有关，但与改善临床结局无关。需要进一步研究以确定特定的维生素补充剂是否对该人群有益。
