预后
住院患者的死亡率为 5%-15%,但在需要入住重症监护病房(intensive care unit, ICU)的患者中,死亡率增加至 20%-50%。[6]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 [118]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 在社区接受治疗的患者通常预后良好。[1]Lim WS, Baudouin SV, George RC, et al; Pneumonia Guidelines Committee of the BTS Standards of Care Committee. British Thoracic Society guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009 Oct;64(suppl 3):iii1-55. https://thorax.bmj.com/content/64/Suppl_3/iii1.long http://www.ncbi.nlm.nih.gov/pubmed/19783532?tool=bestpractice.com
与 30 天死亡率相关的危险因素包括菌血症、收住 ICU、合并症(尤其是神经系统疾病)以及感染潜在多药耐药病原体(例如金黄色葡萄球菌、铜绿假单胞菌、肠杆菌)。[34]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 [143]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 [144]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 [145]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。[160]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 [161]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。[162]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
内容使用需遵循免责声明