免疫抑制构成社区获得性肺炎(CAP)的重大风险。然而,免疫抑制的具体原因及其与发病率的相关性,CAP的病因和预后研究不足。我们从2015年至2018年在德国的法定健康保险中进行了一项基于人群的队列研究。CAP通过ICD-10-GM代码检索。通过编码条件(血液肿瘤,干细胞或器官移植,中性粒细胞减少症,艾滋病毒,原发性免疫抑制综合征)或治疗(免疫抑制剂,抗肿瘤药物,全身性类固醇)。终点定义为CAP的发生(主要),住院治疗,与罕见病原体相关的30天死亡率和CAP。我们的分析使用了经性别调整的Andersen-Gill模型,年龄,长期护理水平,疫苗接种状况,社区类型和合并症.942,008个人,包括54,781个CAPs(住院55%,30天死亡率14.5%)。6%的个体在研究期间显示至少一次免疫抑制发作,以全身性类固醇(39.8%)和血液肿瘤(26.7%)最常见。在7.7%的CAPs中记录到免疫抑制。除了传统的风险因素,如年龄和长期护理水平,免疫抑制患者最容易发生CAP(HR2.4[2.3-2.5])和连续死亡(HR1.9[1.8-2.1]).器官和干细胞移植(HR3.2[2.6-4.0]和2.8[2.1-3.7],分别),HIV(HR3.2[1.9-5.4])和全身性类固醇(>20mg泼尼松日剂量当量(HR2.7[2.4-3.1]))显示感染CAP的风险最高。罕见病原体引起的CAP与免疫抑制密切相关(HR17.1[12.0-24.5]),尤其是HIV(HR34.1[7.6-153])和全身性类固醇(HR8.2[4.6-14.8])。我们的研究阐明了包括全身性类固醇在内的特定免疫抑制状况与CAP的发生和预后的相关性。
Immunosuppression constitutes a significant risk for community-acquired pneumonia (CAP). Nevertheless, specific causes of
immunosuppression and their relevance for incidence, etiology and prognosis of CAP are insufficiently investigated.We conducted a population-based cohort study within a statutory health insurance in Germany from 2015 to 2018. CAP was retrieved by ICD-10-GM codes. Episodes of immunosuppression were identified by coded conditions (hematologic neoplasms, stem cell or organ
transplantation, neutropenia, HIV, primary immunosuppressive syndromes) or treatments (immunosuppressants, antineoplastic drugs, systemic steroids). Endpoints were defined as occurrence of CAP (primary), hospitalization, 30-day mortality and CAP associated with rare pathogens. Our analysis utilized the Andersen-Gill model adjusted for sex, age, level of long-term care, vaccination status, community type and comorbidities.942,008 individuals with 54,781 CAPs were included (hospitalization 55%, 30-day mortality 14.5%). 6% of individuals showed at least one episode of immunosuppression during the study period with systemic steroids (39.8%) and hematologic neoplasms (26.7%) being most common.
Immunosuppression was recorded in 7.7% of CAPs. Besides classical risk factors such as age and level of long-term care, immunosuppressed patients were most prone to CAP (HR 2.4[2.3-2.5]) and consecutive death (HR 1.9[1.8-2.1]). Organ and stem cell
transplantation (HR 3.2[2.6-4.0] and 2.8[2.1-3.7], respectively), HIV (HR 3.2[1.9-5.4]) and systemic steroids (> 20 mg prednisone daily dose equivalent (HR 2.7[2.4-3.1])) showed the highest risk for contracting CAP. CAP by rare pathogens was strongly associated with immunosuppression (HR 17.1[12.0-24.5]), especially HIV (HR 34.1[7.6-153]) and systemic steroids (HR 8.2[4.6-14.8]).Our study elucidates the relevance of particular immunosuppressive conditions including systemic steroids for occurrence and prognosis of CAP.