预后由三大主要因素决定:患者年龄、总体健康状况(是否有并存疾病)以及进行抗生素治疗时所处的医疗环境。一般而言,门诊患者的死亡率<1%,住院患者的死亡率介于 5~15% 之间,但对于需要收住 ICU 的患者,死亡率则上升到 20~50% 。[32]Torres A, Peetermans WE, Viegi G, et al. Risk factors for community-acquired pneumonia in adults in Europe: a literature review. Thorax. 2013 Nov;68(11):1057-65.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3812874
http://www.ncbi.nlm.nih.gov/pubmed/24130229?tool=bestpractice.com
[149]Luna HI, Pankey G. The utility of blood culture in patients with community-acquired pneumonia. Ochsner J. 2001 Apr;3(2):85-93.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3116772
http://www.ncbi.nlm.nih.gov/pubmed/21765724?tool=bestpractice.com
与 30 天死亡率升高有关的数种危险因素包括菌血症、收住重症监护病房、并存疾病(尤其是神经系统疾病)以及存在潜在多重耐药性病原菌(例如金黄色葡萄球菌、铜绿假单胞菌、肠杆菌)。[37]Cillóniz C, Polverino E, Ewig S, et al. Impact of age and comorbidity on cause and outcome in community-acquired pneumonia. Chest. 2013 Sep;144(3):999-1007.
http://www.ncbi.nlm.nih.gov/pubmed/23670047?tool=bestpractice.com
[150]Torres A, Cillóniz C, Ferrer M, et al. Bacteraemia and antibiotic-resistant pathogens in community acquired pneumonia: risk and prognosis. Eur Respir J. 2015 May;45(5):1353-63.
http://www.ncbi.nlm.nih.gov/pubmed/25614173?tool=bestpractice.com
[151]Sligl WI, Marrie TJ. Severe community-acquired pneumonia. Crit Care Clin. 2013 Jul;29(3):563-601.
http://www.ncbi.nlm.nih.gov/pubmed/23830654?tool=bestpractice.com
[152]Melzer M, Welch C. 30-day mortality in UK patients with bacteraemic community-acquired pneumonia. Infection. 2013 Oct;41(5):1005-11.
http://www.ncbi.nlm.nih.gov/pubmed/23703286?tool=bestpractice.com
CAP 患者再次入院率介于 7% 至 12% 之间。[153]Jasti H, Mortensen EM, Obrosky DS, et al. Causes and risk factors for rehospitalization of patients hospitalized with community-acquired pneumonia. Clin Infect Dis. 2008 Feb 15;46(4):550-6.
http://cid.oxfordjournals.org/content/46/4/550.full
http://www.ncbi.nlm.nih.gov/pubmed/18194099?tool=bestpractice.com
[154]Capelastegui A, España Yandiola PP, Quintana JM, et al. Predictors of short-term rehospitalization following discharge of patients hospitalized with community-acquired pneumonia. Chest. 2009 Oct;136(4):1079-85.
http://www.ncbi.nlm.nih.gov/pubmed/19395580?tool=bestpractice.com
在大多数情况下,再次入院的原因都是共病急性加重(主要为心血管疾病、肺部疾病或神经系统疾病)。
正在研究作为死亡率预测指标的预后生物标志物,例如前肾上腺髓质素、激素原形式的心房利尿钠肽、皮质醇、原降钙素和 C 反应蛋白;但在临床实践中将这些生物标志物用于此功能之前,仍需要进一步的研究。[155]Viasus D, Del Rio-Pertuz G, Simonetti AF, et al. Biomarkers for predicting short-term mortality in community-acquired pneumonia: a systematic review and meta-analysis. J Infect. 2016 Mar;72(3):273-82.
http://www.ncbi.nlm.nih.gov/pubmed/26777314?tool=bestpractice.com
快速序贯器官衰竭评价(quick Sequential Organ Failure Assessment,qSOFA)是一种新型筛查工具,已用于识别死亡风险高的感染患者。一项荟萃分析发现,qSOFA 得分≥2 与肺炎患者的死亡率密切相关;然而该评分的敏感性差,仍需进一步研究。[156]Jiang J, Yang J, Jin Y, et al. Role of qSOFA in predicting mortality of pneumonia: a systematic review and meta-analysis. Medicine (Baltimore). 2018 Oct;97(40):e12634.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6200542
http://www.ncbi.nlm.nih.gov/pubmed/30290639?tool=bestpractice.com