Saitz R, Ghali W A, Moskowitz M A
Research Unit, Boston Medical Center, Boston University School of Medicine, Mass, USA.
Arch Intern Med. 1997 Jul 14;157(13):1446-52.
There is controversy regarding the role of alcoholism as a prognostic factor in hospitalized patients with pneumonia.
To assess the impact of alcohol abuse on hospitalization charges, length of hospital stay, intensive care unit use, and in-hospital mortality.
We studied a cohort of all adults hospitalized in 1992 in Massachusetts with a principal diagnosis of pneumonia, and all Massachusetts residents hospitalized for pneumonia in 6 bordering states.
For the 23,198 pneumonia cases the mean total hospitalization charges were $9925, mean length of hospital stay was 9.6 days, 12% of the cases had intensive care unit stays, and 10% of the cases died during the hospitalization. In bivariate analyses, pneumonia cases with alcohol-related diagnoses had higher charges (mean, $11,232 vs $9877, P = .07), had shorter length of hospital stay (9.2 vs 9.6 days, P = .02), were more likely to experience an intensive care unit stay (19% vs 12%, P < .001), and had lower in-hospital mortality (6.0% vs 10.2%, P < .001). Multivariable analyses adjusting for comorbidity, pneumonia etiology, and demographics revealed that for pneumonia cases with alcohol-related diagnoses, risk-adjusted hospital charges were $1293 higher (adjusted mean, $11,179 vs $9888, P < .001), length of hospital stay was 0.6 days longer (10.1 vs 9.5 days, P = .001), intensive care unit use was higher (18% vs 12%; adjusted odds ratio, 1.63; 95% confidence interval, 1.33-1.98), and mortality was no different (10% with or without an alcohol-related diagnosis).
Having an alcohol-related diagnosis is associated with more use of intensive care, longer inpatient stays, and higher hospital charges. To understand resource utilization in cases of pneumonia, alcohol abuse is a comorbid factor that must be considered.
关于酗酒作为肺炎住院患者预后因素的作用存在争议。
评估酒精滥用对住院费用、住院时间、重症监护病房使用情况及院内死亡率的影响。
我们研究了1992年在马萨诸塞州住院且主要诊断为肺炎的所有成年患者队列，以及6个毗邻州因肺炎住院的所有马萨诸塞州居民。
对于23198例肺炎病例，平均总住院费用为9925美元，平均住院时间为9.6天，12%的病例入住重症监护病房，10%的病例在住院期间死亡。在双变量分析中，有酒精相关诊断的肺炎病例费用更高（平均11232美元对9877美元，P = 0.07），住院时间更短（9.2天对9.6天，P = 0.02），更有可能入住重症监护病房（19%对12%，P < 0.001），且院内死亡率更低（6.0%对10.2%，P < 0.001）。调整合并症、肺炎病因和人口统计学因素后的多变量分析显示，对于有酒精相关诊断的肺炎病例，风险调整后的住院费用高出1293美元（调整后平均11179美元对9888美元，P < 0.001），住院时间长0.6天（10.1天对9.5天，P = 0.001），重症监护病房使用率更高（18%对12%；调整后的优势比为1.63；95%置信区间为1.33 - 1.98），死亡率无差异（有或无酒精相关诊断的死亡率均为10%）。
有酒精相关诊断与更多地使用重症监护、更长的住院时间和更高的住院费用相关。为了解肺炎病例中的资源利用情况，酒精滥用是一个必须考虑的合并症因素。
