肺炎 vs 移植功能障碍作为肺移植后急性呼吸衰竭的原因:四年多中心前瞻性研究153年成人需要重症监护承认JF -欧洲呼吸杂志》乔和J - 10.1183/13993003.01512 -2018欧元六世- 54 - 3 SP - 1801512 AU梅佐Cristopher AU -桥,特蕾莎修女AU - Ballesteros玛丽亚·a . AU -洛佩兹Eloisa盟——Rellan Luzdivina AU -罗伯斯,胡安·c . AU - RelloJordi Y1 - 2019/09/01 UR - //www.qdcxjkg.com/content/54/3/1801512.abstract N2 -我们旨在评估肺移植成人重症监护病房(ICU)再入院的主要原因，并确定ICU死亡率的独立预测因素(主要终点)。这项西班牙5个中心的前瞻性队列研究纳入了2012年至2016年期间移植术后ICU出院后再次入院的所有肺移植成人。随访患者直至出院或死亡。153名肺移植受者在移植后6个月(2-25个月)的中位(四分位数范围)在ICU中再入院174例。39例(25.5%)受者报告慢性异体肺移植功能障碍，其中13例(均在体外)有限制性异体肺移植综合征(RAS)。急性呼吸衰竭(ARF)(110例(71.9%))是ICU再入院的主要原因。移植排斥(6例(5.4%)急性)仅导致12例(10.8%)再入院，而肺炎(56例(36.6%))是主要原因(50例ARF和6例休克)，铜绿假单胞菌(50%耐多药)是主要病原体。在ICU死亡55例(35.9%)，在医院死亡69例(45.1%)。多变量分析显示，阻塞性毛细支气管炎综合征(BOS) 2期(校正OR 7.2 (95% CI 1.0-65.7))、BOS 3期(校正OR 13.7 (95% CI 2.5 - 95.3))、RAS (OR >50)和ICU再入院时肺炎(aOR 2.5 (95% CI 1.0-7.1))是ICU死亡率的独立预测因素。 Only eight (5.2%) patients had positive donor-specific antibodies prior to ICU readmission and this variable did not affect the model.ARF was the main condition requiring ICU readmission in lung transplant recipients and was associated with high mortality. Pneumonia was the main cause of death and was also an independent predictor. RAS should receive palliative care rather than ICU admission.In lung transplant adults, pneumonia causes most ICU readmissions and independently influences risk of death, as chronic lung allograft dysfunction also does, particularly the restrictive phenotype. However, acute allograft dysfunction is far less common http://bit.ly/2Xvitv5 ER -