Development of a prediction model for postoperative pneumonia A multicentre prospective observational study

被引：43

作者：

Russotto, Vincenzo ^{[1
]}

Sabate, Sergi ^{[2
,45
]}

Canet, Jaume ^{[3
,4
,57
]}

Langeron, Olivier ^{[14
]}

de Abreu, Marcelo Gama ^{[18
]}

Gallart, Lluis ^{[56
]}

Javier Belda, F. ^{[48
]}

Pelosi, Paolo ^{[24
]}

Hoeft, Andreas ^{[17
]}

Mazo, Valentin ^{[57
]}

Leva, Brigitte ^{[5
]}

Burimi, Jonela ^{[6
]}

Halefi, Toma ^{[6
]}

Hoxha, Aleksander ^{[6
]}

Pilika, Kliti ^{[6
]}

Selmani, Imelda ^{[6
]}

Daout, Ve'ronique ^{[7
]}

Gauthier, Caroline ^{[7
]}

Kahn, David ^{[7
]}

Momeni, Mona ^{[7
]}

Watremez, Christine ^{[7
]}

Straus, Slavenka ^{[8
]}

Djonovic-manovic, Dejana ^{[9
]}

Juros-Zovko, Marina ^{[9
]}

Komen-Usljebrka, Helga ^{[10
]}

Orlic, Vlasta ^{[10
]}

Stuck, Ivana ^{[10
]}

Balakova, Lenka ^{[11
]}

Kosinova, Martina ^{[11
]}

Krikava, Ivo ^{[11
]}

Stoudek, Roman ^{[11
]}

Stourac, Petr ^{[11
]}

Zadrazilova, Katarina ^{[11
]}

Janvekar, Sanober ^{[12
]}

Karjagin, Juri ^{[13
]}

Roivassepp, Kadri ^{[13
]}

Sormus, Alar ^{[13
]}

Cuvillon, Philippe ^{[14
]}

Ibanez-Esteve, Cristina ^{[14
]}

Raux, Mathieu ^{[14
]}

Nicolas-Robin, Armelle ^{[14
]}

Winter, Andre ^{[15
]}

Brunier, Malte ^{[16
]}

Engelhard, Kristin ^{[16
]}

Feldmann, Rita Laufenberg ^{[16
]}

Lindemann, Raphaele ^{[16
]}

Mauff, Susanne ^{[16
]}

Sebastiani, Anne ^{[16
]}

Zamperoni, Camila ^{[16
]}

Hoeft, Andreas ^{[17
]}

机构：

[1] Univ Hosp San Gerardo, Dept Emergency & Intens Care, ASST Monza, Via GB Pergolesi 33, I-20900 Monza, Italy

[2] Fundacio Puigvert IUNA, Dept Anaesthesiol, Barcelona, Spain

[3] Hosp Badalona Germans Trias & Pujol, Dept Anaesthesiol & Crit Care, Barcelona, Spain

[4] Hosp Badalona Germans Trias & Pujol, Barcelona, Spain

[5] European Soc Anaesthesiol Aisbl, Brussels, Belgium

[6] Univ Hosp Ctr Mother Theresa, Tirana, Albania

[7] Catholic Univ Louvain, Clin Univ St Luc, ASBL, Brussels, Belgium

[8] Univ Sarajevo, Ctr Clin, Ctr Heart, Sarajevo, Bosnia & Herceg

[9] Gen Hosp Prim Dr Abdulah Nakas, Sarajevo, Bosnia & Herceg

[10] Univ Hosp Rijeka, Rijka, Croatia

[11] Fac Hosp Brno, Brno, Czech Republic

[12] Masaryks Hosp Usti Nad Labem, Usti Nad Labem, Czech Republic

[13] Tartu Univ Hosp, Tartu, Estonia

[14] Hop La Pitie Salpetriere, Paris, France

[15] Klinikum Darmstadt GmbH, Darmstadt, Germany

[16] Johannes Gutenberg Univ Mainz, Med Ctr, Mainz, Germany

[17] Univ Hosp Bonn, Bonn, Germany

[18] Dresden Univ Technonol, Univ Hosp Carl Gustav Carus, Dresden, Germany

[19] MISEK Kft, Miskolc, Hungary

[20] Azienda Osped, Padua, Italy

[21] Azienda Osped S Croce & Carle, Cuneo, Italy

[22] Azienda USL 5 Pisa Osped F Lotti, Pontedera, Italy

[23] European Inst Oncol, Milan, Italy

[24] IRCCS San Martino, Genoa, Italy

[25] Osped St Orsola Malpighi, Bologna, Italy

[26] Univ Insubria, Varese, Italy

[27] Univ Milan, Osped San Paolo, Milan, Italy

[28] Pauls Stradins Clin Univ Hosp, Riga, Latvia

[29] Kaunas Med Univ Hosp, Kaunas, Lithuania

[30] Vilnius Univ Hosp Santariskiu Clin, Vilnius, Lithuania

[31] ZithaKlinik, Luxembourg, Luxembourg

[32] 10 Wojskowy Szpital Klin & Poliklin Bydgoszczy Go, Bydgoszcz, Poland

[33] Hosp Univ Coimbra, EPE, Coimbra, Portugal

[34] Ctr Hosp Lisboa Ocidental, Lisbon, Portugal

[35] Hosp Fernando Fonseca, Lisbon, Portugal

[36] Inst Portugues Oncol Porto, Porto, Portugal

[37] Emergency Clin Hosp Constanta, Constanta, Romania

[38] Emergency Cty Hosp Clin Anaesthesia & Intens Care, Targu Mures, Romania

[39] Emergency Inst Cardiovasc Dis Prof Dr CC Iliescu, Bucharest, Romania

[40] Krasnoyarsk State Med Univ, Krasnoyarsk, Russia

[41] Clin Univ Navarra, Pamplona, Spain

[42] Consorcio Hosp Gen Univ Valencia, Valencia, Spain

[43] Corporacio Sanitaria Parc Tauli, Barcelona, Sabadell, Spain

[44] Fundacio Althaia, Manresa, Spain

[45] Fundacio Puigvert, Barcelona, Spain

[46] Hosp Arnau Vilanova, Lleida, Spain

[47] Hosp Clin Barcelona, Barcelona, Spain

[48] Hosp Clin Univ Valencia, Valencia, Spain

[49] Hosp Denia, Denia, Spain

[50] Hosp Tajo Aranjuez, Madrid, Spain

来源：

EUROPEAN JOURNAL OF ANAESTHESIOLOGY | 2019年 / 36卷 / 02期

关键词：

PULMONARY COMPLICATIONS; HYDROXYETHYL STARCH; HEMORRHAGIC-SHOCK; RISK; RESUSCITATION; VALIDATION; INFECTION; SCORE;

D O I：

10.1097/EJA.0000000000000921

中图分类号：

R614 [麻醉学];

学科分类号：

100217 ;

摘要：

BACKGROUND Postoperative pneumonia is associated with increased morbidity, mortality and costs. Prediction models of pneumonia that are currently available are based on retrospectively collected data and administrative coding systems. OBJECTIVE To identify independent variables associated with the occurrence of postoperative pneumonia. DESIGN A prospective observational study of a multicentre cohort (Prospective Evaluation of a RIsk Score for postoperative pulmonary COmPlications in Europe database). SETTING Sixty-three hospitals in Europe. PATIENTS Patients undergoing surgery under general and/or regional anaesthesia during a 7-day recruitment period. MAIN OUTCOME MEASURE The primary outcome was postoperative pneumonia. Definition: the need for treatment with antibiotics for a respiratory infection and at least one of the following criteria: new or changed sputum; new or changed lung opacities on a clinically indicated chest radiograph; temperature more than 38.3 degrees C; leucocyte count more than 12 000 mu l(-1). RESULTS Postoperative pneumonia occurred in 120 out of 5094 patients (2.4%). Eighty-two of the 120 (68.3%) patients with pneumonia required ICU admission, compared with 399 of the 4974 (8.0%) without pneumonia (P < 0.001). We identified five variables independently associated with postoperative pneumonia: functional status [odds ratio (OR) 2.28, 95% confidence interval (CI) 1.58 to 3.12], pre-operative SpO(2) values while breathing room air (OR 0.83, 95% CI 0.78 to 0.84), intra-operative colloid administration (OR 2.97, 95% CI 1.94 to 3.99), intra-operative blood transfusion (OR 2.19, 95% CI 1.41 to 4.71) and surgical site (open upper abdominal surgery OR 3.98, 95% CI 2.19 to 7.59). The model had good discrimination (c-statistic 0.89) and calibration (Hosmer-Lemeshow P = 0.572). CONCLUSION We identified five variables independently associated with postoperative pneumonia. The model performed well and after external validation may be used for risk stratification and management of patients at risk of postoperative pneumonia.

引用

页码：93 / 104

页数：12

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