Association between short-term fine particulate matter exposure and hospital-acquired pneumonia risk in critically ill post-cardiac surgery patients: a 10-year cohort study using distributed lag non-linear models
4 affiliations
- 1Intensive Care Unit (ICU), Department of Cardiac Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University
- 2Department of Medical Data, School of Public Health, Cheeloo College of Medicine, Shandong University
- 3Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University
- 4Department of Anesthesiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University
Abstract
Background: Ambient air pollution (AAP) exposure is a substantial health threat to humans globally. However, whether AAP could promote hospital-acquired pneumonia (HAP) onset in critically ill patients, a vulnerable population undergoing cardiac surgery in the intensive care unit (ICU), remains elusive. This study evaluated the correlation of HAP onset with fine particulate matter (PM 2.5 ).
Methods: In total, this study included 6,196 patients who underwent cardiovascular surgery at the ICU of a major hospital in Shandong province, China, over 10 years, from January 1, 2014, to December 31, 2023. The daily mean levels of sulfur dioxide (SO ₂ ), PM 2.5 , carbon monoxide (CO), PM ₁₀ , and ozone (O ₃ ) were assessed from publicly available data. The outcome was HAP, defined according to CDC/NHSN pneumonia criteria as pneumonia developing >48 h after hospital admission and not present or incubating at admission; VAP was not analyzed as a separate endpoint. The association between PM 2.5 and HAP was estimated via a distributed lag non-linear model, adjusted for pollutants, time trends, and weather conditions.
Results: This study analyzed 1938 (31.278%) HAP cases. The mean levels of PM ₁₀ , O ₃ , PM 2.5 , and SO ₂ were 120, 75, 59, and 25 μg/m ³ , respectively, and the mean CO level was 0.979 mg/m ³ . The association between PM 2.5 and HAP was statistically significant at lag 1 day within the perioperative exposure window. At a PM 2.5 concentration of 30 μg/m ³ compared with the reference concentration of 10 μg/m ³ , 14.2% higher odds of HAP were observed (95% CI: 2.6–27%). The stratified analyses indicated stronger associations among elders aged ≥ 60 years, patients with body mass index (BMI) > 23.9 kg/m ² and patients with diabetes. Additional adjustment for clinical covariates, including duration of mechanical ventilation, confirmed the robustness of the observed exposure–response association.
Conclusion: These findings revealed a substantial and robust link between short-term PM 2.5 exposure and elevated HAP incidence in the vulnerable population undergoing cardiovascular surgeries.
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BibTeX
@article{li2026association,
title = {{Association between short-term fine particulate matter exposure and hospital-acquired pneumonia risk in critically ill post-cardiac surgery patients: a 10-year cohort study using distributed lag non-linear models}},
author = {Tianshuo Li and Yuanyuan Yu and Chenmin Liu and Zhiheng Liu and Qi Tan and Wang Li},
journal = {Frontiers in Public Health},
year = {2026},
month = oct,
doi = {10.3389/fpubh.2026.1867760},
url = {https://www.frontiersin.org/articles/10.3389/fpubh.2026.1867760/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Association between short-term fine particulate matter exposure and hospital-acquired pneumonia risk in critically ill post-cardiac surgery patients: a 10-year cohort study using distributed lag non-linear models
AU - Tianshuo Li
AU - Yuanyuan Yu
AU - Chenmin Liu
AU - Zhiheng Liu
AU - Qi Tan
AU - Wang Li
PY - 2026
DA - 2026/10/22
JO - Frontiers in Public Health
DO - 10.3389/fpubh.2026.1867760
UR - https://www.frontiersin.org/articles/10.3389/fpubh.2026.1867760/full
AB - Background: Ambient air pollution (AAP) exposure is a substantial health threat to humans globally. However, whether AAP could promote hospital-acquired pneumonia (HAP) onset in critically ill patients, a vulnerable population undergoing cardiac surgery in the intensive care unit (ICU), remains elusive. This study evaluated the correlation of HAP onset with fine particulate matter (PM 2.5 ). Methods: In total, this study included 6,196 patients who underwent cardiovascular surgery at the ICU of a major hospital in Shandong province, China, over 10 years, from January 1, 2014, to December 31, 2023. The daily mean levels of sulfur dioxide (SO ₂ ), PM 2.5 , carbon monoxide (CO), PM ₁₀ , and ozone (O ₃ ) were assessed from publicly available data. The outcome was HAP, defined according to CDC/NHSN pneumonia criteria as pneumonia developing >48 h after hospital admission and not present or incubating at admission; VAP was not analyzed as a separate endpoint. The association between PM 2.5 and HAP was estimated via a distributed lag non-linear model, adjusted for pollutants, time trends, and weather conditions. Results: This study analyzed 1938 (31.278%) HAP cases. The mean levels of PM ₁₀ , O ₃ , PM 2.5 , and SO ₂ were 120, 75, 59, and 25 μg/m ³ , respectively, and the mean CO level was 0.979 mg/m ³ . The association between PM 2.5 and HAP was statistically significant at lag 1 day within the perioperative exposure window. At a PM 2.5 concentration of 30 μg/m ³ compared with the reference concentration of 10 μg/m ³ , 14.2% higher odds of HAP were observed (95% CI: 2.6–27%). The stratified analyses indicated stronger associations among elders aged ≥ 60 years, patients with body mass index (BMI) > 23.9 kg/m ² and patients with diabetes. Additional adjustment for clinical covariates, including duration of mechanical ventilation, confirmed the robustness of the observed exposure–response association. Conclusion: These findings revealed a substantial and robust link between short-term PM 2.5 exposure and elevated HAP incidence in the vulnerable population undergoing cardiovascular surgeries.
SN - 2296-2565
ER -