Objective
To establish a model for prognosis analysis of severe community-acquired pneumonia in order to find the independent risk factors for mortality.
Methods
The data of 88 patients with severe community-acquired pneumonia enrolled from 533 community-acquired pneumonia patients in Fujian Provincial Hospital from April 2012 to December 2015 were analyzed, they were divided into a survival group and a death group according to prognosis. The clinical materials of basic data of the population, clinical manifestation, treatment and prognosis and pulmonary severity indexes were collected. Then univariate analysis was used to screen risk factors of death before logistic multivaritae regression was applied to explore independent risk factors.
Results
The different pathogen groups including viral, bacterial, mixed infection, negative and other groups were compared and no differences were found in mortality (all P>0.05). Univariate analysis revealed antibiotics treatment before admission, higher APACHEⅡ score, higher Chalison's score, septicopyemia, and higher level of procalcitonin, blood urea nitrogen (BUN), blood glucose, lactate could increase death risk for the patients. While antiviral treatment and no invasive mechanical ventilation were determined as protective factors. Logistic multivaritae regression showed three factors including higher lactate and higher serum BUN and higher heart rates were independent death risk factors [OR values were 4.704 (95%CI 0.966-22.907), 1.264 (95%CI 0.994-1.606), and 1.081 (95%CI 1.003-1.165), respectively]. Whereas no invasive mechanical ventilation was protective factor (OR=0.033, 95%CI 0.001-0.764).
Conclusion
The patients with higher lactate and BUN, higher heart rate and accepting invasive mechanical ventilation have poor prognosis.
Citation：
LI Hongru, LIN Xiaohong, LIN Dan, CHEN Shijie, YU Ting, MAO Wenping, LV Huiying, LIAN Fayang, XIE Jianfeng, ZHENG Kuicheng, CHEN Yusheng. Prognosis analysis of severe community-acquired pneumonia. Chinese Journal of Respiratory and Critical Care Medicine, 2018, 17(5): 450-455. doi: 10.7507/1671-6205.201804017
Copy
Copyright © the editorial department of Chinese Journal of Respiratory and Critical Care Medicine of West China Medical Publisher. All rights reserved
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- 1. Rozenbaum MH, Mangen MJ, Huijts SM, et al. Incidence, direct costs and duration of hospitalization of patients hospitalized with community acquired pneumonia: a nationwide retrospective claims database analysis. Vaccine, 2015, 33(28): 3193-3199.
- 2. Wunderink RG, Waterer GW. Clinical practice. Community-acquired pneumonia. N Engl J Med, 2014, 370(6): 543-551.
- 3. Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America; American Thoracic Society: Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis, 2007, 44(Suppl 2): S27-S72.
- 4. 陈愉生, 王大璇, 李鸿茹, 等. 环介导等温扩增技术在下呼吸道感染常见病原体检测中的应用. 中华结核和呼吸杂志, 2014, 37(4): 270-273.
- 5. Chen YS, Li HR, Zhang W, et al. Development of a bead-based suspension array for the detection of pathogens in acute respiratory tract infections. Exp Biol Med (Maywood), 2016, 241(14): 1551-1558.
- 6. Renaud B, Labarère J, Coma E, et al. Risk stratification of early admission to the intensive care unit of patients with no major criteria of severe community-acquired pneumonia: development of an international prediction rule. Crit Care, 2009, 13(2): R54.
- 7. Guven H, Ahintop L, Baydin A, et al. Diagnostic value procalcitonin levels as early indicator of sepsis. Am J Emerg Med, 2002, 20(3): 202-206.
- 8. Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med, 2001, 345(19): 1368-1377.
- 9. Moine P, Vercken JB, Chevret S, et al. Severe community-acquired pneumococcal pneumonia. The French Study Group of Community-Acquired Pneumonia in ICU. Scand J Infect Dis, 1995, 27(3): 201-206.
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