Risk factors for 30-day mortality in patients with pneumonia who receive appropriate initial antibiotics: an observational cohort study

被引：58

作者：

Shindo, Yuichiro ^{[1
,2
]}

Ito, Ryota ^{[2
,3
]}

Kobayashi, Daisuke ^{[2
,4
]}

Ando, Masahiko ^{[5
]}

Ichikawa, Motoshi ^{[6
,7
]}

Goto, Yasuhiro ^{[8
,9
]}

Fukui, Yasutaka ^{[10
]}

Iwaki, Mai ^{[11
]}

Okumura, Junya ^{[12
]}

Yamaguchi, Ikuo ^{[13
]}

Yagi, Tetsuya ^{[14
]}

Tanikawa, Yoshimasa ^{[6
]}

Sugino, Yasuteru ^{[12
]}

Shindoh, Joe ^{[15
]}

Ogasawara, Tomohiko ^{[11
]}

Nomura, Fumio ^{[3
]}

Saka, Hideo ^{[16
]}

Yamamoto, Masashi ^{[8
]}

Taniguchi, Hiroyuki ^{[4
]}

Suzuki, Ryujiro ^{[10
]}

Saito, Hiroshi ^{[17
]}

Kawamura, Takashi ^{[18
]}

Hasegawa, Yoshinori ^{[2
]}

机构：

[1] Nagoya Univ, Inst Adv Res, Nagoya, Aichi 4668550, Japan

[2] Nagoya Univ, Grad Sch Med, Dept Resp Med, Nagoya, Aichi 4668550, Japan

[3] Japanese Red Cross Nagoya Daiichi Hosp, Dept Resp Med, Nagoya, Aichi, Japan

[4] Tosei Gen Hosp, Dept Resp Med & Allergy, Seto, Japan

[5] Nagoya Univ Hosp, Ctr Adv Med & Clin Res, Nagoya, Aichi, Japan

[6] Toyota Kosei Hosp, Dept Resp Med & Allergy, Toyota, Japan

[7] Gifu Prefectural Tajimi Hosp, Dept Resp Med, Tajimi, Japan

[8] Nagoya Ekisaikai Hosp, Dept Resp Med, Nagoya, Aichi, Japan

[9] Fujita Hlth Univ, Dept Internal Med, Div Resp Med & Clin Allergy, Toyoake, Aichi, Japan

[10] Toyohashi Municipal Hosp, Dept Resp Med, Toyohashi, Aichi, Japan

[11] Nagoya Daini Red Cross Hosp, Dept Resp Med, Nagoya, Aichi, Japan

[12] Toyota Mem Hosp, Dept Resp Med, Toyota, Japan

[13] Toyohashi Municipal Hosp, Dept Cent Lab, Toyohashi, Aichi, Japan

[14] Nagoya Univ Hosp, Dept Infect Dis, Nagoya, Aichi, Japan

[15] Ogaki Municipal Hosp, Dept Resp Med, Ogaki, Japan

[16] Nagoya Med Ctr, Natl Hosp Org, Dept Resp Med, Nagoya, Aichi, Japan

[17] Aichi Hosp, Aichi Canc Ctr, Dept Resp Med, Okazaki, Aichi, Japan

[18] Kyoto Univ, Hlth Serv, Kyoto, Japan

来源：

LANCET INFECTIOUS DISEASES | 2015年 / 15卷 / 09期

关键词：

PREDICTION RULE; INTENSIVE-CARE; HEALTH; VALIDATION; THERAPY; FAILURE; SEPSIS;

D O I：

10.1016/S1473-3099(15)00151-6

中图分类号：

R51 [传染病];

学科分类号：

100401 ;

摘要：

Background Appropriate initial antibiotics are essential for the treatment of infectious diseases. However, some patients with pneumonia might develop adverse outcomes, despite receiving appropriate initial antibiotics. We aimed to clarify the risk factors for 30-day mortality in patients who received appropriate initial antibiotics and to identify potential candidates who would benefit from adjunctive therapy. Methods From March 15, to Dec 22, 2010, we did a prospective, observational study at ten medical institutions in hospitalised patients (aged >= 20 years) with pneumonia. We did a multivariable logistic regression analysis to calculate odds ratios (ORs) and 95% CI to assess the risk factors for 30-day mortality. This study was registered with the University Medical Information Network in Japan, number UMIN000003306. Findings The 30-day mortality was 11% (61 of 579 patients) in the appropriate initial antibiotic treatment group and 17% (29 of 168) in the inappropriate initial antibiotic treatment group. Albumin concentration of less than 30 mg/L (adjusted OR 3.39, 95% CI 1.83-6.28), non-ambulatory status (3.34, 1.84-6.05), pH of less than 7.35 (3.13, 1.52-6.42), respiration rate of at least 30 breaths per min (2.33, 1.28-4.24), and blood urea nitrogen of at least 7.14 mmol/L (2.20, 1.13-4.30) were independent risk factors in patients given appropriate initial antibiotic treatment. The 30-day mortality was 1% (one of 126 patients), 1% (two of 168), 17% (23 of 137), 22% (20 of 89), and 44% (14 of 32) for patients with no, one, two, three, and four or five risk factors, respectively. Interpretation Patients with two or more risk factors were at a higher risk of death during the 30 days assessed than were individuals with no or one risk factor, despite appropriate initial antibiotic treatment. Therefore, adjunctive therapy might be important for improving outcomes in patients with two or more risk factors.

引用

页码：1055 / 1065

页数：11

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