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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7.	吴宗劲, 华海湖, 葛海锋, 等. 序贯机械通气治疗重症肺炎的临床研究[J]. 齐齐哈尔医学院学报, 2015, 36(17):2514-2516.
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10.	徐吉, 潘怀富. 机械通气早期乳酸清除率对重症COPD患者预后的影响[J]. 临床医学, 2014, 34(10):89-90.
11.	许卉军. 无创机械通气治疗重症肺炎呼吸衰竭观察[J]. 中国现代药物应用, 2015, 9(9):79-80.
12.	陈妙霞, 胡细玲, 马盈盈, 等. 慢性阻塞性肺疾病机械通气并发呼吸机依赖患者早期康复活动的安全性[J]. 广东医学, 2015, 36(10):1631-1632.
13.	华文良, 汤超, 汤文夏. 气管插管并人工机械通气抢救严重急性呼吸衰竭患者临床分析[J]. 中国现代医生, 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.	李飞, 李惠. 重症肺炎死亡患者的早期临床特征及死亡预测因素分析[J]. 中国呼吸与危重监护杂志, 2013, 12(3):249-252.
16.	莫光洲. 无创呼吸机早期治疗和延迟治疗在COPD急性发作中的效果[J]. 泰山医学院学报, 2014, 35(5):372-374.
17.	乔铭, 杨亚芳. 无创机械通气治疗COPD合并呼吸衰竭的临床观察[J]. 中国当代医药, 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. 刘震, 刘启蒙, 赵丽, 等. 急诊成人重症社区获得性肺炎的病原学调查及分析[J]. 中国呼吸与危重监护杂志, 2015, 14(1):42-47.
2. 陈恒屹, 崔社怀. 重症社区获得性肺炎病死率及预后分析[J]. 中华肺部疾病杂志:电子版, 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. 重症社区获得性肺炎评价的研究进展[J]. 临床肺科杂志, 2012, 17(12):2266-2268.
7. 吴宗劲, 华海湖, 葛海锋, 等. 序贯机械通气治疗重症肺炎的临床研究[J]. 齐齐哈尔医学院学报, 2015, 36(17):2514-2516.
8. 黄涛. 无创呼吸机治疗慢性阻塞性肺疾病合并呼吸衰竭疗效观察[J]. 中外医疗, 2013, 32(35):57, 59.
9. 郭琦, 李海燕, 周一平, 等. 重症社区获得性肺炎9项次要诊断标准权重[J]. 海南医学, 2011, 22(15):6-11.
10. 徐吉, 潘怀富. 机械通气早期乳酸清除率对重症COPD患者预后的影响[J]. 临床医学, 2014, 34(10):89-90.
11. 许卉军. 无创机械通气治疗重症肺炎呼吸衰竭观察[J]. 中国现代药物应用, 2015, 9(9):79-80.
12. 陈妙霞, 胡细玲, 马盈盈, 等. 慢性阻塞性肺疾病机械通气并发呼吸机依赖患者早期康复活动的安全性[J]. 广东医学, 2015, 36(10):1631-1632.
13. 华文良, 汤超, 汤文夏. 气管插管并人工机械通气抢救严重急性呼吸衰竭患者临床分析[J]. 中国现代医生, 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. 李飞, 李惠. 重症肺炎死亡患者的早期临床特征及死亡预测因素分析[J]. 中国呼吸与危重监护杂志, 2013, 12(3):249-252.
16. 莫光洲. 无创呼吸机早期治疗和延迟治疗在COPD急性发作中的效果[J]. 泰山医学院学报, 2014, 35(5):372-374.
17. 乔铭, 杨亚芳. 无创机械通气治疗COPD合并呼吸衰竭的临床观察[J]. 中国当代医药, 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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