Abstract：
The guidelines for the requirement of Legionella urinary antigen tests on admission for patients hospitalized with community-acquired pneumonia differ in Japan, the United States, and Europe. We aimed to evaluate the association between the timing of Legionella urinary antigen testing and inhospital mortality in patients with atypical pneumonia.
We identified 654,708 patients with atypical pneumonia from July 2010 to March 2021 using the Japanese national inpatient database. The patients were divided into groups that underwent Legionella urinary antigen tests on the day of admission (test group, n = 229,649) and those that underwent testing after the day of admission or were untested (control group, n = 425,059). A propensity score-stabilized inverse probability of treatment weighting analysis was performed to compare inhospital mortality, length of hospital stay, and total hospitalization costs between the two groups. Odds ratios (ORs) or differences and their 95% confidence intervals (CIs) were calculated using generalized linear models.
The tested group had a significantly lower 30-day inhospital mortality than that of the control group (7.7% vs. 9.0%; OR: 0.83 [95% CIs, 0.81-0.86]). The tested group also had a significantly shorter length of stay (difference, -2.3 [-2.6 to - 2.0] days and total hospitalization costs (-396 [-508 to - 285] US dollars) than that of the control group.
Legionella urinary antigen testing upon admission is associated with better outcomes in patients with atypical pneumonia. Legionella urinary antigen testing performed on the day of admission is recommended for hospitalized patients with atypical pneumonia.
We identified 654,708 patients with atypical pneumonia from July 2010 to March 2021 using the Japanese national inpatient database. The patients were divided into groups that underwent Legionella urinary antigen tests on the day of admission (test group, n = 229,649) and those that underwent testing after the day of admission or were untested (control group, n = 425,059). A propensity score-stabilized inverse probability of treatment weighting analysis was performed to compare inhospital mortality, length of hospital stay, and total hospitalization costs between the two groups. Odds ratios (ORs) or differences and their 95% confidence intervals (CIs) were calculated using generalized linear models.
The tested group had a significantly lower 30-day inhospital mortality than that of the control group (7.7% vs. 9.0%; OR: 0.83 [95% CIs, 0.81-0.86]). The tested group also had a significantly shorter length of stay (difference, -2.3 [-2.6 to - 2.0] days and total hospitalization costs (-396 [-508 to - 285] US dollars) than that of the control group.
Legionella urinary antigen testing upon admission is associated with better outcomes in patients with atypical pneumonia. Legionella urinary antigen testing performed on the day of admission is recommended for hospitalized patients with atypical pneumonia.
摘要：
■在日本，社区获得性肺炎住院患者入院时军团菌尿抗原检测要求的指南有所不同，美国,和欧洲。我们旨在评估非典型肺炎患者军团菌尿抗原检测时间与住院死亡率之间的关系。
■我们使用日本国家住院患者数据库从2010年7月到2021年3月确定了654,708例非典型肺炎患者。将患者分为入院当天进行军团菌尿抗原检测的组(试验组,n=229,649）和入院当天后接受测试或未经测试的人（对照组，n=425,059)。进行倾向评分稳定的治疗加权反概率分析，以比较住院死亡率，住院时间,两组的总住院费用。使用广义线性模型计算赔率（OR）或差异及其95％置信区间（CI）。
■测试组的30天住院死亡率明显低于对照组（7.7％vs.9.0%；OR：0.83[95%CI，0.81-0.86])。测试组的住院时间也明显较短(差异，-2.3[-2.6至-2.0]天和总住院费用（-396[-508至-285]美元）比对照组。
■非典型肺炎患者入院时军团菌尿抗原检测与更好的预后相关。非典型肺炎住院患者建议在入院当天进行军团菌尿抗原检测。
■我们使用日本国家住院患者数据库从2010年7月到2021年3月确定了654,708例非典型肺炎患者。将患者分为入院当天进行军团菌尿抗原检测的组(试验组,n=229,649）和入院当天后接受测试或未经测试的人（对照组，n=425,059)。进行倾向评分稳定的治疗加权反概率分析，以比较住院死亡率，住院时间,两组的总住院费用。使用广义线性模型计算赔率（OR）或差异及其95％置信区间（CI）。
■测试组的30天住院死亡率明显低于对照组（7.7％vs.9.0%；OR：0.83[95%CI，0.81-0.86])。测试组的住院时间也明显较短(差异，-2.3[-2.6至-2.0]天和总住院费用（-396[-508至-285]美元）比对照组。
■非典型肺炎患者入院时军团菌尿抗原检测与更好的预后相关。非典型肺炎住院患者建议在入院当天进行军团菌尿抗原检测。
