血嗜酸性粒细胞计数与冠状动脉旁路移植手术后肺炎风险（英文）
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摘要
目的:研究血嗜酸性粒细胞计数与冠状动脉旁路移植手术患者术后肺炎风险的关系。方法:收集2008年~2017年在我院进行冠状动脉旁路移植手术的613例患者资料进行分析,比较不同血嗜酸性粒细胞计数患者术后肺炎发生率及住院死亡率,采用多因素回归分析明确患者术后肺炎的危险因素。结果:研究共纳入582例患者,其中220例患者血嗜酸性粒细胞比例<2%(低血嗜酸性粒细胞组),362例患者血嗜酸性粒细胞比例≥2%(高血嗜酸性粒细胞组)。低血嗜酸性粒细胞组术后肺炎发生率(14.1%,31/220)明显高于高血嗜酸性粒细胞组(6.4%,23/362,P=0.002),而2组患者住院死亡率无明显差异。多因素回归分析结果显示低血嗜酸性粒细胞计数(OR=3.521,95%CI:1.213~10.223,P=0.021)、鼻胃管(OR=6.490,95%CI:2.757~15.280,P<0.001)和机械通气时间≥24 h(OR=3.496,95%CI:1.156~10.178,P=0.035)为术后发生肺炎的独立危险因素。结论:低血嗜酸性粒细胞计数患者冠状动脉旁路移植手术后发生肺炎的风险升高。
AIM: To investigate the relationship between blood eosinophil count and risk of postoperative pneumonia in patients with coronary artery bypass graft( CABG) surgery. METHODS: The medical records of 613 patients who underwent CABG surgery from January 2008 to December 2017 in our hospital were collected and reviewed. The incidence of postoperative pneumonia and hospital mortality were compared in the patients with low or high blood eosinophil count. The risk factors for postoperative pneumonia following CABG surgery were analyzed by multiple logistic regression. RESULTS:The patients enrolled in the study were 582,in which 220 patients had preoperative blood eosinophil counts of less than 2%( low blood eosinophil count) and 362 patients had eosinophil counts of 2% or more( high blood eosinophil count). The incidence of postoperative pneumonia in the patients with low blood eosinophil count was 14. 1%( 31/220),significantly higher than that( 6. 4%,23/362) in the patients with high blood eosinophil count( P = 0. 002). However,the hospital mortality of the patients with high or low blood eosinophil count had no difference. Low blood eosinophil count( OR = 3. 521,95% CI: 1. 213 ～ 10. 223,P = 0. 021),nasogastric tube( OR = 6. 490,95% CI: 2. 757 ～ 15. 280,P < 0. 001) and mechanical ventilation ≥24 h( OR = 3. 496,95% CI: 1. 156 ～ 10. 178,P = 0. 035) were identified as independent risk factors for postoperative pneumonia following CABG surgery. CONCLUSION: Low blood eosinophil count is associated with increased risk of postoperative pneumonia following CABG surgery.
AIM: To investigate the relationship between blood eosinophil count and risk of postoperative pneumonia in patients with coronary artery bypass graft( CABG) surgery. METHODS: The medical records of 613 patients who underwent CABG surgery from January 2008 to December 2017 in our hospital were collected and reviewed. The incidence of postoperative pneumonia and hospital mortality were compared in the patients with low or high blood eosinophil count. The risk factors for postoperative pneumonia following CABG surgery were analyzed by multiple logistic regression. RESULTS:The patients enrolled in the study were 582,in which 220 patients had preoperative blood eosinophil counts of less than 2%( low blood eosinophil count) and 362 patients had eosinophil counts of 2% or more( high blood eosinophil count). The incidence of postoperative pneumonia in the patients with low blood eosinophil count was 14. 1%( 31/220),significantly higher than that( 6. 4%,23/362) in the patients with high blood eosinophil count( P = 0. 002). However,the hospital mortality of the patients with high or low blood eosinophil count had no difference. Low blood eosinophil count( OR = 3. 521,95% CI: 1. 213 ～ 10. 223,P = 0. 021),nasogastric tube( OR = 6. 490,95% CI: 2. 757 ～ 15. 280,P < 0. 001) and mechanical ventilation ≥24 h( OR = 3. 496,95% CI: 1. 156 ～ 10. 178,P = 0. 035) were identified as independent risk factors for postoperative pneumonia following CABG surgery. CONCLUSION: Low blood eosinophil count is associated with increased risk of postoperative pneumonia following CABG surgery.
引文
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[10]Allou N,Bronchard R,Guglielminotti J,et al.Risk factors for postoperative pneumonia after cardiac surgery and development of a preoperative risk score[J].Crit Care Med,2014,42(5):1150-1156.
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[12]Pascoe S,Locantore N,Dransfield MT,et al.Blood eosinophil counts,exacerbations,and response to the addition of inhaled fluticasone furoate to vilanterol in patients[[[with chronic obstructive pulmonary disease:a secondary analysis of data from two parallel randomised controlled trials[J].Lancet Respir Med,2015,3(6):435-442.
[13]Guzmán-Herrador B,Molina CD,Allam MF,et al.Independent risk factors associated with hospital-acquired pneumonia in an adult ICU:4-year prospective cohort study in a university reference hospital[J].J Public Health(Oxf),2016,38(2):378-383.
[14]Ding C,Zhang Y,Yang Z,et al.Incidence,temporal trend and factors associated with ventilator-associated pneumonia in mainland China:a systematic review and meta-analysis[J].BMC Infect Dis,2017,17:468.
[15]Herkel T,Uvizl R,Doubravska L,et al.Epidemiology of hospital-acquired pneumonia:results of a Central European multicenter,prospective,observational study compared with data from the European region[J].Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub,2016,160(3):448-455.
[2]Abidi K,Belayachi J,Derras Y,et al.Eosinopenia,an early marker of increased mortality in critically ill medical patients[J].Intensive Care Med,2011,37(7):1136-1142.
[3]Abidi K,Khoudri I,Belayachi J,et al.Eosinopenia is a reliable marker of sepsis on admission to medical intensive care units[J].Crit Care,2008,12(2):R59.
[4]Vedel-Krogh S,Nordestgaard BG,Lange P,et al.Blood eosinophil count and risk of pneumonia hospitalisations in individuals with COPD[J].Eur Respir J,2018,51(5):1800120.
[5]Pavord ID,Lettis S,Anzueto A,et al.Blood eosinophil count and pneumonia risk in patients with chronic obstructive pulmonary disease:a patient-level meta-analysis[J].Lancet Respir Med,2016,4(9):731-741.
[6]Vedel-Krogh S,Nielsen SF,Lange P,et al.Blood eosinophils and exacerbations in chronic obstructive pulmonary disease.The Copenhagen General Population Study[J].Am J Respir Crit Care Med,2016,193(9):965-974.
[7]Levine GN,Bates ER,Bittl JA,et al.2016 ACC/AHAguideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease:a report of the american college of cardiology/american heart association task force on clinical practice guidelines[J].J Thorac Cardiovasc Surg,2016,152(5):1243-1275.
[8]Brescia AA,Rankin JS,Cyr DD,et al.Determinants of variation in pneumonia rates after coronary artery bypass grafting[J].Ann Thorac Surg,2018,105(2):513-520.
[9]Strobel RJ,Liang Q,Zhang M,et al.A preoperative risk model for postoperative pneumonia after coronary artery bypass grafting[J].Ann Thorac Surg,2016,102(4):1213-1219.
[10]Allou N,Bronchard R,Guglielminotti J,et al.Risk factors for postoperative pneumonia after cardiac surgery and development of a preoperative risk score[J].Crit Care Med,2014,42(5):1150-1156.
[11]Toor IS,Jaumdally R,Lip GY,et al.Eosinophil count predicts mortality following percutaneous coronary intervention[J].Thromb Res,2012,130(4):607-611.
[12]Pascoe S,Locantore N,Dransfield MT,et al.Blood eosinophil counts,exacerbations,and response to the addition of inhaled fluticasone furoate to vilanterol in patients[[[with chronic obstructive pulmonary disease:a secondary analysis of data from two parallel randomised controlled trials[J].Lancet Respir Med,2015,3(6):435-442.
[13]Guzmán-Herrador B,Molina CD,Allam MF,et al.Independent risk factors associated with hospital-acquired pneumonia in an adult ICU:4-year prospective cohort study in a university reference hospital[J].J Public Health(Oxf),2016,38(2):378-383.
[14]Ding C,Zhang Y,Yang Z,et al.Incidence,temporal trend and factors associated with ventilator-associated pneumonia in mainland China:a systematic review and meta-analysis[J].BMC Infect Dis,2017,17:468.
[15]Herkel T,Uvizl R,Doubravska L,et al.Epidemiology of hospital-acquired pneumonia:results of a Central European multicenter,prospective,observational study compared with data from the European region[J].Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub,2016,160(3):448-455.