重新评估社区获得性肺炎治疗中的哈尔姆临床稳定性标准。

IF 16.6 1区 医学 Q1 RESPIRATORY SYSTEM European Respiratory Journal Pub Date : 2024-11-07 Print Date: 2024-11-01 DOI:10.1183/13993003.00054-2024
Simone Bastrup Israelsen, Markus Fally, Pernille Brok Nielsen, Lilian Kolte, Kasper Karmark Iversen, Pernille Ravn, Thomas Benfield
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引用次数: 0

摘要

简介:长期以来,Halm 临床稳定性标准一直指导着社区获得性肺炎(CAP)住院患者的抗生素治疗和出院决定。这些标准最初于 1998 年推出,是根据相对较小的特定患者群体制定的。因此,我们的研究旨在重新评估这些标准在当代真实世界环境中对 CAP 管理的适用性:这项队列研究纳入了 2017-2020 年间在丹麦三家医院住院的 2918 名免疫功能正常的 CAP 患者。主要结果是达到哈尔姆标准定义的临床稳定时间。此外,我们还考察了临床不稳定和严重并发症的复发情况。考虑到竞争风险,我们采用累积发病率函数或卡普兰-梅耶生存曲线来分析这些结果:研究对象主要是患有严重并发症的老年人(中位年龄:75 岁)。根据哈尔姆标准,临床稳定的中位时间为4天,五分之一的患者在早期临床反应(3天内稳定)后再次出现不稳定。30天内的严重并发症主要包括死亡率,早期临床反应患者的死亡率为5.1%(64/1257),无拒绝复苏指令的亚组死亡率为1.7%(18/1045),其余患者的死亡率为17.3%(276/1595):Halm的临床稳定性标准有效地对不同病程的CAP患者进行了分类,但对于合并症较多、病情较重的高龄人群来说,实现临床稳定性需要更多的时间。早期临床反应表明并发症风险降低,尤其是那些没有下达拒绝复苏命令的患者。
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Reassessing Halm's clinical stability criteria in community-acquired pneumonia management.

Background: Halm's clinical stability criteria have long guided antibiotic treatment and hospital discharge decisions for patients hospitalised with community-acquired pneumonia (CAP). Originally introduced in 1998, these criteria were established based on a relatively small and select patient population. Consequently, our study aims to reassess their applicability in the management of CAP in a contemporary real-world setting.

Methods: This cohort study included 2918 immunocompetent patients hospitalised with CAP from three hospitals in Denmark between 2017 and 2020. The primary outcome was time to achieve clinical stability as defined by Halm's criteria. Additionally, we examined recurrence of clinical instability and severe complications. Cumulative incidence function or Kaplan-Meier survival curves were used to analyse these outcomes, considering competing risks.

Results: The study population primarily comprised elderly individuals (median age 75 years) with significant comorbidities. The median time to clinical stability according to Halm's criteria was 4 days, with one-fifth experiencing recurrence of instability after early clinical response (stability within 3 days). Severe complications within 30 days mainly comprised mortality, with rates of 5.1% (64/1257) overall in those with early clinical response, 1.7% (18/1045) in the subgroup without do-not-resuscitate orders and 17.3% (276/1595) among the rest.

Conclusion: Halm's clinical stability criteria effectively classify CAP patients with different disease courses, yet achieving stability required more time in this ageing population with substantial comorbidities and more severe disease. Early clinical response indicates reduced risk of complications, especially in those without do-not-resuscitate orders.

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来源期刊
European Respiratory Journal
European Respiratory Journal 医学-呼吸系统
CiteScore
27.50
自引率
3.30%
发文量
345
审稿时长
2-4 weeks
期刊介绍: The European Respiratory Journal (ERJ) is the flagship journal of the European Respiratory Society. It has a current impact factor of 24.9. The journal covers various aspects of adult and paediatric respiratory medicine, including cell biology, epidemiology, immunology, oncology, pathophysiology, imaging, occupational medicine, intensive care, sleep medicine, and thoracic surgery. In addition to original research material, the ERJ publishes editorial commentaries, reviews, short research letters, and correspondence to the editor. The articles are published continuously and collected into 12 monthly issues in two volumes per year.
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