Analysis of Clinical Features of Severe Community-acquired Pneumonia and Predictive Factors of Death_West China Medical Journal

Authors：

 XIEZheng-liang ,  GUOLu , LIUYue-jian

Department of Respiratory Medicine, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan 610072, P. R. China;

Corresponding?author：

GUOLu, Email: guolu134@163.com

Keywords：

Community-acquired pneumonia; Severe; Clinical features; Death; Predictors

DOI：

10.7507/1002-0179.20150464

Video：

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Objective To investigate the clinical characteristics and predicting factors for death in critically ill patients with severe community-acquired pneumonia (CAP). Method A total of 143 hospitalized patients with severe CAP between January 2009 and December 2012 were included and their clinical data were retrospectively analyzed. According to the clinical outcome, patients were divided into survival group and death group, and their clinical features and laboratory test results were compared, and multivariate regression analysis was conducted to search for predicting factors for death. Results In this study, a total of 118 patients survived and 25 patients died, and the mortality rate was 17.5%. The number of underlying diseases in the two groups were different, and death group had more patients with 3 kinds of diseases than the survival group[76.0% (19/25) vs. 22.8% (13/57), P<0.05]. The intubation rate in the death group was significantly higher than that in the survival group[84.0% (21/25) vs. 33.1% (39/118), P<0.05], and the arterial blood pH value (7.15±0.52 vs. 7.42±0.17, P<0.05), HCO3- concentration[(18.07±6.25) vs. (25.07±5.44) mmol/L, P<0.05], PaO₂[(58.92±35.18) vs. (85.92±32.19) mm Hg (1 mm Hg=0.133 kPa), P<0.05] and PaO₂/FiO₂[(118.23±98.02) vs. (260.17±151.22) mm Hg, P<0.05)] in the death group were significantly lower than those in the survival group. And multivariate regression analysis indicated that the number of underlying diseases[OR=0.202, 95%CI (0.198, 0.421), P=0.003], PaO₂[OR=1.203, 95%CI (1.193, 1.294), P=0.011] and PaO₂/FiO₂[OR=0.956, 95%CI (0.927, 0.971), P=0.008] were independent predictors of death in the patients with severe pneumonia. Conclusions Patients who died of severe pneumonia often had severe illnesses before admission, and the number of underlying diseases and PaO₂ have highly predictive value for death.

Citation： XIEZheng-liang, GUOLu, LIUYue-jian. Analysis of Clinical Features of Severe Community-acquired Pneumonia and Predictive Factors of Death. West China Medical Journal, 2015, 30(9): 1618-1621. doi: 10.7507/1002-0179.20150464 Copy

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10.	徐吉, 潘懷富. 機械通氣早期乳酸清除率對重癥COPD患者預后的影響[J]. 臨床醫學, 2014, 34(10):89-90.
11.	許卉軍. 無創機械通氣治療重癥肺炎呼吸衰竭觀察[J]. 中國現代藥物應用, 2015, 9(9):79-80.
12.	陳妙霞, 胡細玲, 馬盈盈, 等. 慢性阻塞性肺疾病機械通氣并發呼吸機依賴患者早期康復活動的安全性[J]. 廣東醫學, 2015, 36(10):1631-1632.
13.	華文良, 湯超, 湯文夏. 氣管插管并人工機械通氣搶救嚴重急性呼吸衰竭患者臨床分析[J]. 中國現代醫生, 2014, 52(32):158-160.
14.	Gil DR, Undurraga PA, Saldías PF, et al. Prognostic factors and outcome of community-acquired pneumonia in hospitalized adult patients[J]. Rev Med Chil, 2006, 134(11):1357-1366.
15.	李飛, 李惠. 重癥肺炎死亡患者的早期臨床特征及死亡預測因素分析[J]. 中國呼吸與危重監護雜志, 2013, 12(3):249-252.
16.	莫光洲. 無創呼吸機早期治療和延遲治療在COPD急性發作中的效果[J]. 泰山醫學院學報, 2014, 35(5):372-374.
17.	喬銘, 楊亞芳. 無創機械通氣治療COPD合并呼吸衰竭的臨床觀察[J]. 中國當代醫藥, 2011, 18(26):19-20.
18.	Wu CL, Lin FJ, Lee SY, et al. Early evolution of arterial oxygenation in severe community-acquired pneumonia:a prospective observational study[J]. J Crit Care, 2007, 22(2):129-136.

1. 劉震, 劉啟蒙, 趙麗, 等. 急診成人重癥社區獲得性肺炎的病原學調查及分析[J]. 中國呼吸與危重監護雜志, 2015, 14(1):42-47.
2. 陳恒屹, 崔社懷. 重癥社區獲得性肺炎病死率及預后分析[J]. 中華肺部疾病雜志:電子版, 2010, 3(5):332-335.
3. Watkins RR, Lemonovich TL. Diagnosis and management of community-acquired pneumonia in adults[J]. Am Fam Physician, 2011, 83(11):1299-1306.
4. Wilson PA, Ferguson J. Severe community-acquired pneumonia:an Australian perspective[J]. Intern Med J, 2005, 35(12):699-705.
5. Mandell LA, Wunderink RG, Anzueto A, et al. Infectious diseases society of America/American thoracic society consensus guidelines on the management of community-acquired pneumonia in adults[J]. Clin Infect Dis, 2007, 44(Suppl 2):S27-S72.
6. 查日田. 重癥社區獲得性肺炎評價的研究進展[J]. 臨床肺科雜志, 2012, 17(12):2266-2268.
7. 吳宗勁, 華海湖, 葛海鋒, 等. 序貫機械通氣治療重癥肺炎的臨床研究[J]. 齊齊哈爾醫學院學報, 2015, 36(17):2514-2516.
8. 黃濤. 無創呼吸機治療慢性阻塞性肺疾病合并呼吸衰竭療效觀察[J]. 中外醫療, 2013, 32(35):57, 59.
9. 郭琦, 李海燕, 周一平, 等. 重癥社區獲得性肺炎9項次要診斷標準權重[J]. 海南醫學, 2011, 22(15):6-11.
10. 徐吉, 潘懷富. 機械通氣早期乳酸清除率對重癥COPD患者預后的影響[J]. 臨床醫學, 2014, 34(10):89-90.
11. 許卉軍. 無創機械通氣治療重癥肺炎呼吸衰竭觀察[J]. 中國現代藥物應用, 2015, 9(9):79-80.
12. 陳妙霞, 胡細玲, 馬盈盈, 等. 慢性阻塞性肺疾病機械通氣并發呼吸機依賴患者早期康復活動的安全性[J]. 廣東醫學, 2015, 36(10):1631-1632.
13. 華文良, 湯超, 湯文夏. 氣管插管并人工機械通氣搶救嚴重急性呼吸衰竭患者臨床分析[J]. 中國現代醫生, 2014, 52(32):158-160.
14. Gil DR, Undurraga PA, Saldías PF, et al. Prognostic factors and outcome of community-acquired pneumonia in hospitalized adult patients[J]. Rev Med Chil, 2006, 134(11):1357-1366.
15. 李飛, 李惠. 重癥肺炎死亡患者的早期臨床特征及死亡預測因素分析[J]. 中國呼吸與危重監護雜志, 2013, 12(3):249-252.
16. 莫光洲. 無創呼吸機早期治療和延遲治療在COPD急性發作中的效果[J]. 泰山醫學院學報, 2014, 35(5):372-374.
17. 喬銘, 楊亞芳. 無創機械通氣治療COPD合并呼吸衰竭的臨床觀察[J]. 中國當代醫藥, 2011, 18(26):19-20.
18. Wu CL, Lin FJ, Lee SY, et al. Early evolution of arterial oxygenation in severe community-acquired pneumonia:a prospective observational study[J]. J Crit Care, 2007, 22(2):129-136.

West China Medical Journal

Analysis of Clinical Features of Severe Community-acquired Pneumonia and Predictive Factors of Death

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