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Epidemiology and treatment outcome of pneumonia: Analysis based on Japan national database.

肺炎流行病学学和治疗结果: 基于日本国家数据库的分析。

  • 影响因子:1.67
  • DOI:10.1016/j.jiac.2019.07.001
  • 作者列表:"Igari H","Yamagishi K","Yamazaki S","Murata S","Yahaba M","Takayanagi S","Kawasaki Y","Taniguchi T
  • 发表时间:2020-01-01
Abstract

:Pneumonia is the third leading cause of death in Japan. Mortality increases at an accelerating rate in elderly patients aged ≥65 years. Elderly patients tend to have underlying conditions affecting pneumonia treatment. The national database (NDB) associated with medical services under Japanese universal health insurance is available for research purposes. Our NDB randomly sampled 10% of hospitalized patients every October from 2011 to 2014. In this NDB, we analyzed pneumonia epidemiology in patients aged ≥15 years and 30-day mortality in Japanese hospitals. This study also investigated the factors affecting treatment outcome. A total of 9386 patients were entered. The number of patients from age 65 years and older increased greatly, representing 85% of the total. The thirty-day mortality rate among all patients was 11.7%. Mortality rates at age 15-64, 65-74, 75-84, and ≥85 years were 9.5%, 12.0%, 8.3%, and 14.9%, respectively, showing significant differences (P < 0.001). The underlying conditions varied among age groups. Male gender, age, heart failure, chronic kidney disease (CKD), consciousness disorder, shock and respiratory failure are risk factors for 30-day mortality. Pneumonia develops mainly in people aged 65 years and older in Japan, and treatment outcome is generally poor in elderly patients. The underlying conditions were seen to affect the 30-day mortality rate. CURB-65 and ADROP, a modification of CURB-65 in Japan, have already estimated these risk factors, and heart failure and CKD might be additional factors for estimating pneumonia severity.

摘要

: 肺炎是日本的第三大死因。年龄 ≥ 65 岁的老年患者死亡率加速增加。老年患者往往有影响肺炎治疗的基础疾病。与日本全民健康保险医疗服务相关的国家数据库 (NDB) 可用于研究目的。我们的NDB从 2011 年到 2014 年每年 10 月随机抽样 10% 的住院患者。在这个NDB中,我们分析了日本医院 ≥ 15 岁和 30 天死亡率患者的肺炎流行病学学。本研究还调查了影响治疗结果的因素。共录入患者 9386 例。65 岁及以上的患者人数大大增加,占总数的 85%。所有患者的 30 天死亡率为 11.7%。15-64 岁、 65-74 岁、 75-84 岁和 ≥ 85 岁的死亡率分别为 9.5% 、 12.0% 、 8.3% 和 14.9%,显示显著差异 (P <0.001)。基础条件因年龄组而异。男性、年龄、心力衰竭、慢性肾脏病 (CKD) 、意识障碍、休克和呼吸衰竭是 30 天死亡的危险因素。日本的肺炎主要发生在 65 岁及以上的人群中,老年患者的治疗结果普遍较差。基础条件被认为会影响 30 天的死亡率。CURB-65 和ADROP,日本CURB-65 的修改,已经估计了这些危险因素,心力衰竭和CKD可能是估计肺炎严重程度的额外因素。

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呼吸道感染方向

呼吸道感染分为上呼吸道感染与下呼吸道感染。上呼吸道感染是指自鼻腔至喉部之间的急性炎症的总称,是最常见的感染性疾病。下呼吸道感染是最常见的感染性疾患,治疗时必须明确引起感染的病原体以选择有效的抗生素。

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