对于以社区获得性肺炎（CAP）入院的成年患者，我们对其共存疾病模式及其对临床护理或结局的影响知之甚少。我们试图评估共存条件在这一人群中的集群分布，以促进对多病种影响CAP的理解。我们在加拿大安大略省的7家医院对11,085名以CAP为入院诊断的成年患者进行了研究。我们使用聚类分析，基于Charlson共病指数中共病的集群化，确定了患者亚群。我们在独立的队列中进行了集群分析的推导和复制（推导样本 2010-2015年，复制样本 2015-2017年），然后将它们结合到总队列中进行最终集群分析。我们描述了药物、影像学和结果的差异。患者分为7个亚群。低共病亚群（n = 3052, 27.5%）没有共病。DM-HF-Pulm亚群具有糖尿病、心力衰竭和慢性肺病（n = 1710, 15.4%）。其他亚群的定义如下：肺（n = 1621, 14.6%），糖尿病（n = 1281, 11.6%），心力衰竭（n = 1370, 12.4%），痴呆（n = 1038, 9.4%）和癌症（n = 1013, 9.1%）。患者使用的皮质类固醇在痴呆和肺亚群分别为11.5%和64.9%。肺炎青霉素-他唑巴坦的使用率在肺和癌亚群分别为9.1%和28.0%。胸部计算机断层扫描的使用率在痴呆和癌亚群分别为5.7%和36.3%。调整患者因素后，与低共病组相比，癌亚群（调整后奥数比 [OR] 3.12，95%置信区间 [CI] 2.44-3.99）、痴呆亚群（调整后OR 1.57，95%CI 1.05-2.35）、心力衰竭亚群（调整后OR 1.66，95%CI 1.35-2.03）和DM-HF-Pulm亚群（调整后OR 1.35，95%CI 1.12-1.61）的住院死亡风险增加，而糖尿病亚群的住院死亡风险降低（调整后OR 0.67，95%CI 0.50-0.89）。以共存病状为基础，入院CAP的患者可分为临床上可识别的亚群。这些亚群之间的临床护理和结果存在差异，目前缺乏指导决策的证据，需要进一步个体化护理的研究。© 2023 CMA Impact Inc. or its licensors.

Little is known about patterns of coexisting conditions and their influence on clinical care or outcomes in adults admitted to hospital for community-acquired pneumonia (CAP). We sought to evaluate how coexisting conditions cluster in this population to advance understanding of how multimorbidity affects CAP.We studied 11 085 adults admitted to hospital with CAP at 7 hospitals in Ontario, Canada. Using cluster analysis, we identified patient subgroups based on clustering of comorbidities in the Charlson Comorbidity Index. We derived and replicated cluster analyses in independent cohorts (derivation sample 2010-2015, replication sample 2015-2017), then combined these into a total cohort for final cluster analyses. We described differences in medications, imaging and outcomes.Patients clustered into 7 subgroups. The low comorbidity subgroup (n = 3052, 27.5%) had no comorbidities. The DM-HF-Pulm subgroup had prevalent diabetes, heart failure and chronic lung disease (n = 1710, 15.4%). One disease category defined each remaining subgroup, as follows: pulmonary (n = 1621, 14.6%), diabetes (n = 1281, 11.6%), heart failure (n = 1370, 12.4%), dementia (n = 1038, 9.4%) and cancer (n = 1013, 9.1%). Corticosteroid use ranged from 11.5% to 64.9% in the dementia and pulmonary subgroups, respectively. Piperacillin-tazobactam use ranged from 9.1% to 28.0% in the pulmonary and cancer subgroups, respectively. The use of thoracic computed tomography ranged from 5.7% to 36.3% in the dementia and cancer subgroups, respectively. Adjusting for patient factors, the risk of in-hospital death was greater in the cancer (adjusted odds ratio [OR] 3.12, 95% confidence interval [CI] 2.44-3.99), dementia (adjusted OR 1.57, 95% CI 1.05-2.35), heart failure (adjusted OR 1.66, 95% CI 1.35-2.03) and DM-HF-Pulm subgroups (adjusted OR 1.35, 95% CI 1.12-1.61), and lower in the diabetes subgroup (adjusted OR 0.67, 95% CI 0.50-0.89), compared with the low comorbidity group.Patients admitted to hospital with CAP cluster into clinically recognizable subgroups based on coexisting conditions. Clinical care and outcomes vary among these subgroups with little evidence to guide decision-making, highlighting opportunities for research to personalize care.© 2023 CMA Impact Inc. or its licensors.