Ingresos hospitalarios y vacunación antigripal en pacientes de alto riesgo

Resumen

Fundamento y objetivo

estudiar el grado de vacunación antigripal de los pacientes de más de 65 años con enfermedades crónicas del ambiente hospitalario que ingresaron por descompensaciones cardiorrespiratorias durante la temporada 2006–2007, y compararlos con los no ingresados.

Pacientes y método

se estudió a seiscientos cuarenta y dos pacientes, con una edad media (desviación estándar) de 74 (10) años, de los que 404 (63%) eran varones. Se consideraron casos los ingresados por descompensaciones cardiorrespiratorias durante la temporada de gripe, y controles, los seguidos en consultas del hospital que no ingresaron dicho año.

Resultados

el número de casos fue de 337 (68%) y el de controles, de 305 (31%). Los casos tenían mayor morbilidad, historia de ingresos hospitalarios y neumonía previa, así como la asociación de 2 o más factores de riesgo, que se registró en 292 casos (85%), frente a 225 controles (73%) (p<0,001). En el análisis multivariable, los factores que más influyeron en la probabilidad de ingreso hospitalario fueron: vacunación antigripal (odds ratio [OR]=0,59; intervalo de confianza [IC] del 95%,0,41–0,86; p=0,006), cardiopatía isquémica crónica (OR=0,59; IC del 95%, 0,40–0,88; p=0,009), hipertensión arterial (OR=1,60; IC del 95%, 1,03–2,47) y hospitalización previa (OR=2,40; IC del 95%, 1,64–3,49; p<0,001).

Conclusiones

en la temporada 2006–2007, en los pacientes del ambiente hospitalario con alto riesgo de presentar complicaciones derivadas de la gripe, el porcentaje de vacunación antigripal fue menor entre los que ingresaron por descompensaciones cardiorrespiratorias que entre quienes no ingresaron. Los médicos hospitalarios deberían insistir en la necesidad de vacunar a sus pacientes.

Abstract

Background and objective

We aimed to analyze the degree of utilization of influenza vaccines in patients who are 65 years and older with decompensated chronic diseases during the 2006–07 influenza epidemic and to compare it with the 2000–01 epidemic. We also investigated the effectiveness of the influenza vaccination in the prevention of incomes for cardiopulmonary illness in this group.

Patients and method

Six hundred and forty two patients were studied; average (standard deviation) age was 74 (10) years, and 404 (63%) were males. Patients considered as cases had been admitted to hospital due to cardiopulmonary illness during the influenza season. Controls were patients attended at hospital but who had not been hospitalized during that period.

Results

The population vaccination rate was 445 (68%). In the vaccination group, 275 (57%) people were 75 year old or more vs 77 (37%) patients in the non-vaccination group (p<0.001); 418 (94%) of the vaccination group had been vaccinated in previous years, vs 96 (46%) in the non-vaccination group (p<0.001). Cases were 337 (68%) vs 305 (31%) controls. Cases had major morbidity, previous hospitalization or pneumonia, as well as 2 or more risk factors —292 (85%) cases vs 225 (73%) controls (p<0.001)—. Factors mostly influencing the possibility of hospitalization were: influenza vaccination (odds ratio [OR]=0.59; 95% confidence interval [CI]: 0.41–0.86; p=0.006), chronic ischemic heart disease (OR=0.59; 95% CI, 0.40–0.88; p=0.009), high blood pressure (OR=1.60; 95% CI, 1.03–2.47), and previous hospitalization (OR=2.40; 95% CI, 1.64–3.49; p<0.001).

Conclusions

In high risk patients, the influenza vaccination rate was improved slightly in the last 6 years. Vaccination was associated with less hospitalization for heart and pulmonary diseases. These benefits of vaccination support future efforts to increase the rates of vaccination among elder patients with chronic diseases, especially if they have not been vaccinated in previous campaigns.