Factors driving outcome variability in aspiration and community-acquired pneumonia: a meta-analysis.

IF 10.4 1区医学 Q1 RESPIRATORY SYSTEM

European Respiratory Review Pub Date : 2025-10-08 Print Date: 2025-10-01 DOI:10.1183/16000617.0037-2025

Jordi Almirall, Ramón Boixeda, Mari C de la Torre, Marcial Cariqueo, Antoni Torres

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Abstract

Background: Aspiration community-acquired pneumonia (ACAP) is common among older adults and is associated with worse outcomes than nonaspiration community-acquired pneumonia (CAP). Understanding these differences is essential for improving patient care.

Objectives: To determine the prevalence of ACAP among pneumonia patients and compare clinical outcomes, including hospital length of stay, intensive care unit (ICU) admissions and mortality rates, between patients with ACAP and those with CAP.

Methods: A systematic review and meta-analysis were conducted following MOOSE (Meta-Analysis of Observational Studies in Epidemiology) and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Literature searches in PubMed, Embase and Google Scholar from January 1995 to January 2024 identified studies involving adults diagnosed with CAP or ACAP. Data extraction and quality assessment were performed independently by two reviewers. Random-effects meta-analysis and meta-regression analyses were conducted to identify sources of heterogeneity.

Results: 49 samples from 44 studies were included, encompassing 1 277 615 older adults (mean age 80.2 years). The pooled prevalence of ACAP was 25% (95% CI 19-31) and higher in studies with a mean age of 70 years or older at 32% (95% CI 25-39). Compared to CAP patients, those with ACAP had significantly longer hospital stays (mean difference 4.92 days, 95% CI 4.71-5.14), increased ICU admissions (risk ratio 2.33, 95% CI 1.77-3.07), higher in-hospital mortality (risk ratio 2.14, 95% CI 1.73-2.65), higher 30-day mortality (risk ratio 2.56, 95% CI 2.12-3.1), higher 1-year mortality (risk ratio 1.96, 95% CI 1.44-2.66) and greater recurrence rates (risk ratio 1.75, 95% CI 1.44-2.66). Meta-regression identified publication year, patient age, study design, nursing home residency and compliance with therapeutic guidelines as significant moderators explaining heterogeneity.

Conclusions: Patients with ACAP experience significantly worse clinical outcomes than those with CAP. These findings highlight the importance of early identification and management of aspiration risks, adherence to therapeutic guidelines and the need for standardised diagnostic criteria to improve outcomes in this vulnerable population.

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导致吸入性和社区获得性肺炎结果变异性的因素：一项荟萃分析。

背景：吸入性社区获得性肺炎（ACAP）在老年人中很常见，其预后比非吸入性社区获得性肺炎（CAP）更差。了解这些差异对于改善患者护理至关重要。目的：确定ACAP在肺炎患者中的患病率，并比较ACAP患者和cap患者的临床结果，包括住院时间、重症监护病房（ICU）入院率和死亡率。方法：根据MOOSE（流行病学观察性研究荟萃分析）和PRISMA（系统评价和荟萃分析的首选报告项目）指南进行系统评价和荟萃分析。1995年1月至2024年1月在PubMed、Embase和谷歌Scholar中检索文献，确定了涉及诊断为CAP或ACAP的成人的研究。数据提取和质量评估由两名审稿人独立完成。进行随机效应荟萃分析和荟萃回归分析以确定异质性的来源。结果：纳入44项研究的49个样本，包括1 277 615名老年人（平均年龄80.2岁）。ACAP的总患病率为25% (95% CI 19-31)，在平均年龄为70岁或以上的研究中，ACAP的总患病率为32% （95% CI 25-39）。与CAP患者相比，ACAP患者的住院时间明显延长（平均差4.92天，95% CI 4.71-5.14）， ICU入院率增加（风险比2.33,95% CI 1.77-3.07），住院死亡率更高（风险比2.14,95% CI 1.73-2.65）， 30天死亡率更高（风险比2.56,95% CI 2.12-3.1）， 1年死亡率更高（风险比1.96,95% CI 1.44-2.66），复发率更高（风险比1.75,95% CI 1.44-2.66）。meta回归发现发表年份、患者年龄、研究设计、养老院居住和治疗指南依从性是解释异质性的重要调节因素。结论：ACAP患者的临床结果明显比CAP患者差。这些发现强调了早期识别和管理误吸风险的重要性，遵守治疗指南，以及需要标准化的诊断标准来改善这一弱势人群的预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Respiratory Review Medicine-Pulmonary and Respiratory Medicine

CiteScore

14.40

自引率

1.30%

发文量

审稿时长

24 weeks

期刊介绍： The European Respiratory Review (ERR) is an open-access journal published by the European Respiratory Society (ERS), serving as a vital resource for respiratory professionals by delivering updates on medicine, science, and surgery in the field. ERR features state-of-the-art review articles, editorials, correspondence, and summaries of recent research findings and studies covering a wide range of topics including COPD, asthma, pulmonary hypertension, interstitial lung disease, lung cancer, tuberculosis, and pulmonary infections. Articles are published continuously and compiled into quarterly issues within a single annual volume.