Abstract

Background

Outcomes of patients with severe pulmonary blastomycosis requiring mechanical ventilation (MV) are not well understood in the modern era. Limited historical case series reported 50–90% mortality in patients with acute respiratory distress syndrome caused by blastomycosis. The objective of this large retrospective cohort study was to describe the risk factors and outcomes of patients with severe pulmonary blastomycosis.

Methods

We performed a retrospective cohort analysis utilizing the Nationwide Inpatient Sample from 2006–2014. Patients aged >18 years with a diagnosis of blastomycosis who received MV were included.

Results

There were 1848 patients with a diagnosis of blastomycosis included in the study. Of these, 219 (11.9%) underwent MV with a mortality rate of 39.7% compared with 2.5% in patients not requiring ventilatory support (P < .01). The median (IQR) time to death for patients requiring MV was 12 (8–16) days. The median length of hospital stay for survivors of MV was 22 (14–37) days. The rate of MV was higher for patients treated in teaching hospitals (63.4% vs 57.2%, P = .05) and lower for those receiving care at a rural hospital (12.3% vs 17.2%, P = .04). In a multivariate model, female gender was associated with increased risk of mortality (OR, 1.84; 95% CI, 1.06–3.20; P = .03) as was increasing patient age (10-year age increase OR, 1.64; 95% CI, 1.33–2.02; P < .01).

Conclusions

In the largest published cohort of patients with blastomycosis, mortality for patients on MV is high at ~40%, 16-fold higher than those without MV.

中文翻译：

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在美国，严重的芽孢杆菌病和呼吸衰竭的结果

摘要

背景

在现代时代，对于需要机械通气（MV）的严重肺母细胞菌病患者的治疗效果还不甚了解。有限的历史病例系列报告了由芽孢杆菌病引起的急性呼吸窘迫综合征患者的死亡率为50-90％。这项大型回顾性队列研究的目的是描述重度肺成纤维细胞病患者的危险因素和结局。

方法

我们使用2006-2014年全国住院患者样本进行了回顾性队列分析。年龄≥18岁且诊断为母芽胞菌病并接受MV的患者也包括在内。

结果

该研究包括1848例诊断为芽孢菌病的患者。在这些患者中，有219名（11.9％）接受了MV，死亡率为39.7％，相比之下，不需要通气支持的患者为2.5％（P <.01）。需要MV的患者的中位（IQR）死亡时间为12（8-16）天。MV幸存者的中位住院时间为22（14–37）天。在教学医院接受治疗的患者的MV较高（63.4％对57.2％，P = .05），而在乡村医院接受治疗的患者对MV较低（12.3％对17.2％，P = .04）。在多变量模型中，女性与死亡风险增加相关（OR，1.84； 95％CI，1.06-3.20；P= .03），随着患者年龄的增加（10岁年龄增加，OR为1.64； 95％CI为1.33–2.02；P <.01）。

结论

在发表的最大的有芽孢菌病患者的队列中，MV患者的死亡率高达〜40％，比不使用MV的患者高16倍。