Background Crude and adjusted mortality rates for patients with non-ventilator hospital-acquired pneumonia (NV-HAP) are among the highest of all healthcare-associated infections, leading to calls for greater prevention. Patients prone to NV-HAP, however, tend to be severely ill at baseline, making it unclear whether their high mortality rates are due to NV-HAP, their underlying conditions, or both. Methods Two infectious disease physicians conducted detailed medical record reviews on 150 randomly selected adults from 4 hospitals who died in-hospital following an NV-HAP event between April 2016 and May 2021. Reviewers abstracted risk factors, estimated the preventability of NV-HAP, identified causes of death, and adjudicated the preventability of death. Results The patients’ median age was 69.3 (IQR, 60.7–77.4) years and 43.3% were female. Comorbidities were common: 57% had cancer, 30% chronic kidney disease, 29% chronic lung disease, and 27% had heart failure. At least 1 hospice-eligible condition was present before NV-HAP in 54% and “Do Not Resuscitate” orders in 24%. Most (99%) had difficult-to-modify NV-HAP risk factors: 76% altered mental status, 35% dysphagia, and 27% nasogastric/orogastric tubes. NV-HAP was deemed possibly or probably preventable in 21% and hospital death likely or very likely preventable in 8.6%. Conclusions Most patients who die following NV-HAP have multiple, severe underlying comorbidities and difficult-to-modify risk factors for NV-HAP. Only 1 in 5 NV-HAPs that culminated in death and 1 in 12 deaths following NV-HAP were judged potentially preventable. This does not diminish the importance of NV-HAP prevention programs but informs expectations about the potential magnitude of their impact on hospital deaths.

中文翻译：

---

非呼吸机医院获得性肺炎患者医院死亡的可预防性


背景 非呼吸机医院获得性肺炎 （NV-HAP） 患者的粗死亡率和调整死亡率是所有医疗保健相关感染中最高的，因此呼吁加强预防。然而，易患 NV-HAP 的患者在基线时往往病情严重，因此尚不清楚他们的高死亡率是由于 NV-HAP、其潜在疾病还是两者兼而有之。方法 两名传染病医生对 2016 年 4 月至 2021 年 5 月期间因 NV-HAP 事件在医院内死亡的 4 家医院随机选择的 150 名成年人进行了详细的病历审查。评价员提取危险因素，估计 NV-HAP 的可预防性，确定死亡原因，并判断死亡的可预防性。结果 患者的中位年龄为 69.3 （IQR， 60.7–77.4） 岁，其中 43.3% 为女性。合并症很常见：57% 患有癌症，30% 患有慢性肾病，29% 患有慢性肺病，27% 患有心力衰竭。54% 的患者在 NV-HAP 之前至少存在 1 种符合临终关怀条件的情况，24% 的患者出现“不复苏”命令。大多数 （99%） 有难以改变的 NV-HAP 危险因素： 76% 的精神状态改变，35% 的吞咽困难和 27% 的鼻胃管/口胃管。21% 的 NV-HAP 被认为可能或可能可预防，8.6% 的医院死亡可能或非常可能可预防。结论 大多数 NV-HAP 后死亡的患者具有多种严重的潜在合并症和难以改变的 NV-HAP 危险因素。只有 1/5 的 NV-HAP 最终导致死亡，NV-HAP 后每 12 例死亡中就有 1 例被判断为潜在可预防的。这并没有降低 NV-HAP 预防计划的重要性，而是让人们了解它们对医院死亡的潜在影响程度。