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Abstract：
Objective Recommendations on the timing of Legionella urinary antigen tests for community-acquired pneumonia patients differ among guidelines in Japan, the United States, and European nations. We therefore evaluated the association between the timing of urinary antigen tests and in-hospital mortality in patients with Legionella pneumonia. Methods We conducted a retrospective cohort study using the Diagnosis Procedure Combination database, a nationwide database of acute care inpatients in Japan. Patients who underwent Legionella urinary antigen tests on the day of admission formed the tested group. Patients who were tested on day 2 of admission or later or were unexamined formed the control group. We performed a propensity score matching analysis to compare in-hospital mortality, length of hospital stay and duration of antibiotics use between the two groups. Results Of the 9,254 eligible patients, 6,933 were included in the tested group. One-to-one propensity score matching generated 1,945 pairs. The tested group had a significantly lower 30-day in-hospital mortality than the control group (5.7 vs. 7.7%; odds ratio, 0.72; 95% confidence intervals, 0.55-0.95; p=0.020). The tested group also showed a significantly shorter length of stay and duration of antibiotics use than the control group. Conclusion Urine antigen testing upon admission was associated with better outcomes in patients with Legionella pneumonia. Urine antigen tests upon admission may be recommended for all patients with severe community-acquired pneumonia.
摘要：
目的在日本的指南中，对社区获得性肺炎患者军团菌尿抗原检测时间的建议有所不同。美国,和欧洲国家。因此，我们评估了军团菌肺炎患者的尿抗原检测时间与院内死亡率之间的关系。方法我们使用诊断程序组合数据库进行了回顾性队列研究，日本全国急性护理住院患者数据库。入院当天接受军团菌尿抗原测试的患者组成测试组。在入院第2天或之后接受测试或未经检查的患者组成对照组。我们进行了倾向评分匹配分析，以比较住院死亡率，两组的住院时间和抗生素使用时间。结果在9,254名合格患者中，6,933包括在测试组中。一对一的倾向得分匹配产生了1,945对。测试组的30天住院死亡率明显低于对照组（5.7vs.7.7%；赔率比，0.72；95%置信区间，0.55-0.95；p=0.020）。与对照组相比，测试组的住院时间和抗生素使用时间也明显缩短。结论军团菌肺炎患者入院时进行尿抗原检测与更好的预后相关。对于所有患有严重社区获得性肺炎的患者，建议在入院时进行尿液抗原检测。
