Abstract
To examine and compare in-hospital mortality (IHM) of community-acquired pneumonia (CAP) and non-ventilator hospital-acquired pneumonia (NV-HAP) among patients with or without bronchiectasis (BQ) using propensity score matching. A retrospective observational epidemiological study using the Spanish Hospital Discharge Records, 2016–17. We identified 257,455 admissions with CAP (3.97% with BQ) and 17,069 with NV-HAP (2.07% with BQ). Patients with CAP and BQ had less comorbidity, lower IHM, and a longer mean length of hospital stay (p < 0.001) than non-BQ patients. They had a higher number of isolated microorganisms, including Pseudomonas aeruginosa. In patients with BQ and NV-HAP, no differences were observed with respect to comorbidity, in-hospital mortality (IHM), or mean length of stay. P. aeruginosa was more frequent (p = 0.028). IHM for CAP and NV-HAP with BQ was 7.89% and 20.06%, respectively. The factors associated with IHM in CAP with BQ were age, comorbidity, pressure ulcers, surgery, dialysis, and invasive ventilation, whereas in NV-HAP with BQ, the determinants were age, metastatic cancer, need for dialysis, and invasive ventilation. Patients with CAP and BQ have less comorbidity, lower IHM and a longer mean length of hospital stay than non-BQ patients. However, they had a higher number of isolated microorganisms, including Pseudomonas aeruginosa. In patients with BQ and NV-HAP, no differences were observed with respect to comorbidity, in-hospital mortality, or mean length of stay, but they had a greater frequency of infection by P. aeruginosa than non-BQ patients. Predictors of IHM for both types of pneumonia among BQ patients included dialysis and invasive ventilation.
Highlights
Bronchiectasis (BQ) is a disease characterized by abnormal and irreversible dilations of the bronchi, with alteration of the ciliary epithelium and secondary symptoms [1]
Our objectives were as follows: (i) to examine the characteristics of community-acquired pneumonia (CAP) and non-ventilator hospital-acquired pneumonia (NV-HAP) among patients with and without BQ in Spain during the period 2016–17; (ii) to compare in-hospital mortality (IHM) for CAP and NV-HAP between patients with and without BQ using propensity score matching (PSM); and (iii) to identify factors associated with IHM after CAP and NV-HAP among patients with BQ
We identified NV-HAP in patients with any ICD-10 codes from J12 to J18 in any diagnosis position and with a Present on Admission” (POA) indicator coded as “N” that had been hospitalized for ≥48 h
Summary
Bronchiectasis (BQ) is a disease characterized by abnormal and irreversible dilations of the bronchi, with alteration of the ciliary epithelium and secondary symptoms [1]. It generally manifests as a cough, expectoration, and persistent or recurrent respiratory infections [2,3,4]. The overall perception and management of BQ has varied dramatically in recent years, and the disease has become increasingly relevant owing to its greater prevalence and the negative impact of its co-occurrence with other diseases. The real prevalence of this condition remains unknown, it is thought to range between 53 and 566 cases per 100,000 inhabitants. BQ more commonly affects women and older people [4,5,6]
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