低收入和中等收入国家ICU中肺炎患者的结局：一项系统综述
该研究针对中低收入国家（LMIC）社区获得性肺炎（CAP）入住ICU患者，通过系统综述与荟萃分析（PROSPERO注册号CRD42022363048）纳入52项研究、48707例患者，发现合并死亡率为37%（95%CI 31-42），需要机械通气者升至61（44-75），年龄和机械通气是短期死亡率最强的调节因素，解释55.2%的异质性。
要点
- LMIC的ICU中CAP患者合并死亡率为37%，机械通气者达61。
- 年龄与机械通气是短期死亡率最强的调节因素（解释55.2%异质性）。
- 研究集中于中高收入国家，缺乏低收入国家数据。
核心结论
- 中等收入国家ICU中CAP患者死亡率仍高，老年及机械通气患者尤甚。
- 缺乏低收入国家数据值得注意。
研究设计与样本
- 系统综述与荟萃分析，检索多数据库，纳入观察性研究与临床试验。
- 共纳入18个国家的52项研究，涵盖48707例患者。
- 主要结局为全因ICU、28天或30天死亡率。
- 研究已在PROSPERO注册（CRD42022363048）。
主要发现
- 最常见合并症为高血压、慢性阻塞性肺疾病和糖尿病。
- 36项研究报告机械通气，中位使用率为59%（四分位距41.4-77.4）。
- 合并死亡率为37%（95%CI 31-42）。
- 需要机械通气者死亡率为61（44-75）。
- 荟萃回归中年龄和机械通气解释55.2%的短期死亡率异质性。
临床怎么用
- 应重点关注老年及需要机械通气的CAP患者，因其死亡风险更高。
- 在中低收入国家ICU资源规划中需考虑机械通气的高使用率与高死亡率。
局限性
- 多数研究来自中高收入国家，未识别到低收入国家的研究。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
NEJM Evid. 2026 Jun;5(6):EVIDoa2500244. doi: 10.1056/EVIDoa2500244. Epub 2026 May 26. ABSTRACT BACKGROUND: Community-acquired pneumonia (CAP) is a leading cause of intensive care unit (ICU) admission and death in low- and middle-income countries (LMICs). We conducted a systematic review and meta-analysis to estimate mortality among patients with CAP admitted to ICUs in LMICs. METHODS: We searched multiple databases using terms related to CAP admitted to the ICU and LMIC. We included both observational studies and clinical trials. The primary outcome was all-cause ICU, 28-day or 30-day mortality. Demographics, comorbidities, clinical characteristics, mechanical ventilation, and length of ICU stay were described. We registered the study in PROSPERO (CRD42022363048). RESULTS: A total of 52 studies from 18 countries met inclusion criteria, encompassing 48,707 patients. Most studies originated in upper-middle-income countries and no studies from low-income countries were identified. The most frequent comorbidities were hypertension, chronic obstructive pulmonary disease, and diabetes. Mechanical ventilation was reported in 36 studies, with median use in 59% (interquartile range, 41.4-77.4) of patients. Pooled mortality was 37% (95% confidence interval [CI], 31-42), rising to 61 (44-75) among patients requiring mechanical ventilation. In a meta-regression, age and mechanical ventilation were the strongest moderators of mortality, explaining 55.2% of heterogeneity in short-term mortality. CONCLUSIONS: Mortality among patients with CAP admitted to ICUs in middle-income countries remains high, especially in older and mechanically ventilated patients. The lack of data from low-income countries is notable. PMID: 42189048 | DOI: 10.1056/EVIDoa2500244
引用
- PubMed 高证据 · 肺炎：Outcomes of Pneumonia in ICUs in Low- and Middle-Income Countries - A Systematic Review
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。