Risk, Severity and Outcome of Bacterial Pneumonia in an HIV +/- Veteran Cohort

HIV/退伍军人群体中细菌性肺炎的风险、严重程度和结果

• 批准号: 7826428
• 负责人: Kristina Anne Crothers
• 金额: $ 50万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-30 至 2011-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7826428
• 关键词: Acute Lung Injury; Address; Adherence; Admission activity; Adult Respiratory Distress Syndrome; Affect; Age; Aging; Alcohol consumption; Alcohols; Area; Bacterial Infections; Bacterial Pneumonia; CD4 Lymphocyte Count; Caring; Clinical; Clinical Research; Cohort Studies; Communities; Data; Development; Diagnosis; Disease; Enrollment; Ethnic Origin; Etiology; Event; Frequencies; Future; Grant; Guidelines; HIV; HIV Infections; Healthcare; Hospitalization; Hospitals; Immune System Diseases; Immunity; Incidence; Individual; Intensive Care Units; Intervention; Knowledge; Lung; Lung diseases; Measures; Mechanical ventilation; Modeling; Morbidity - disease rate; Observational Study; Opportunistic Infections; Organism; Outcome; Oxidative Stress; Patient Care; Patients; Pattern; Persons; Pharmaceutical Preparations; Platelet Factor 4; Pneumocystis carinii Pneumonia; Pneumonia; Pneumonia Severity Index; Population; Predisposition; Preventive; Preventive Medicine; Process; Prospective Studies; Race; Recurrence; Research; Research Personnel; Research Project Grants; Risk; Risk Factors; Role; Severities; Shock; Site; Source; Vasoconstrictor Agents; Veterans; Work; antiretroviral therapy; base; cigarette smoking; cohort; hospital utilization; improved; interest; lung injury; modifiable risk; mortality; prevent; prognostic; public health relevance

DESCRIPTION (provided by applicant): This application addresses broad Challenge Area (04) Clinical Research, specific Challenge Topic 04-HL-104 "Perform secondary analyses of existing data to answer important clinical and preventive medicine research questions." We propose to use existing data from the Veterans Aging Cohort Study (VACS) to examine risk factors for incidence and severity of bacterial pneumonia in HIV infected (HIV+) compared to HIV uninfected (HIV-) patients. VACS is an ongoing multi-site prospective study of 3,413 HIV+ and 3,413 age-, race/ethnicity- and site-matched HIV- patients, enrolled 2001-2002 at 8 US VAMC. We will use the wealth of data that is already available in VACS, and add to this full chart reviews in patients with bacterial pneumonia. We propose the following aims: 1. Determine risk factors for incident and recurrent bacterial pneumonia; 2. Determine risk factors for severity of bacterial pneumonia; 3. Describe hospital utilization and mortality according to severity of bacterial pneumonia. We will comprehensively examine the relationship between risk factors and processes of care with etiology, severity, and outcomes of pneumonia adjusting for potential confounders. Pneumonia events will be validated by chart review and categorized as incident or recurrent, and as community or hospital acquired. Severity of pneumonia will be described by the pneumonia severity index (PSI) at presentation. As rates of bacterial pneumonia remain elevated among HIV+ patients in the current era of combination antiretroviral therapy (CART), even among those with CD4 cell counts >500, we seek to identify potentially modifiable factors that may provide the basis for future preventive studies. In particular, we are interested in alcohol as a risk factor for incidence and severity of pneumonia, as alcohol use is common in HIV+ populations; is associated with increased risk of pneumonia; immune dysfunction; and acute lung injury. Thus, alcohol use, even at low levels in HIV+ patients, may enhance susceptibility to lung injury related to bacterial infection and predispose to severe disease. These analyses will provide results that have an immediate impact to inform patient care, and will provide a basis for intervention work to decrease risk and improve health care and outcomes from bacterial pneumonia. PUBLIC HEALTH RELEVANCE: This research project seeks to identify risk factors in HIV infected and uninfected individuals that influence the development and severity of bacterial pneumonia, a major source of morbidity and mortality world-wide. In particular, we will investigate the relationship of alcohol use and abuse with bacterial pneumonia, as alcohol may increase the risk for lung injury. These studies can inform patient care and provide a basis for future studies aimed at preventing and improving outcomes from bacterial pneumonia.

描述（由申请人提供）：此申请涉及广泛的挑战领域（04）临床研究，具体挑战主题04-HL-104“对现有数据进行次要分析，以回答重要的临床和预防医学研究问题。”我们建议使用退伍军人老化队列研究（VACS）的现有数据来检查与未感染的HIV（HIV-）患者相比，感染HIV感染（HIV+）的细菌性肺炎的发病率和严重程度的危险因素。 VACS是一项正在进行的多站点前瞻性研究，对3,413 HIV+和3,413岁的年龄，种族/种族和现场匹配的HIV患者，在2001 - 2002年在8 US VAMC招收。我们将使用VACS中已经可用的大量数据，并在细菌性肺炎患者中添加全图评论。我们提出以下目的：1。确定出现和复发细菌性肺炎的危险因素； 2。确定细菌性肺炎严重程度的危险因素； 3。根据细菌性肺炎的严重程度来描述医院的利用和死亡率。我们将全面研究风险因素与护理过程与病因，严重程度和肺炎结果调整潜在混杂因素之间的关系。肺炎事件将通过图表审查来验证，并将其分为事件或经常性，并被归类为社区或医院所获得的。肺炎的严重程度将由肺炎严重程度指数（PSI）描述。在当前组合抗逆转录病毒疗法（CART）的HIV+患者中，由于细菌性肺炎的发生率仍然升高，即使在CD4细胞计数> 500> 500的患者中，我们也试图识别可能为未来预防研究提供基础的潜在可修改因素。特别是，我们对酒精作为肺炎发病率和严重程度的危险因素感兴趣，因为在HIV+人群中使用酒精是常见的。与肺炎风险增加有关；免疫功能障碍；和急性肺损伤。因此，即使在艾滋病毒+患者中，酒精的使用，即使在低水平的患者中，也可能增强对与细菌感染和严重疾病易感性肺损伤的易感性。这些分析将提供立即影响患者护理的结果，并为降低风险并改善医疗保健和细菌肺炎的结果提供干预工作的基础。 公共卫生相关性：该研究项目旨在确定影响细菌性肺炎的发育和严重性的艾滋病毒感染和未感染的个体的危险因素，这是全球发病率和死亡率的主要来源。特别是，我们将研究酒精使用和滥用与细菌性肺炎的关系，因为酒精可能会增加肺部损伤的风险。这些研究可以为患者护理提供信息，并为未来的研究提供基础，以防止和改善细菌性肺炎的结局。