Investigation On Etiology And Analysis Of Prognostic Factors Of Severe Community-acquired Pneumonia

Objective:Severe community-acquired pneumonia is a relatively common and potentially fatal condition that is often first encountered in the emergency department (ED), SCAP is still a difficult diseases with poor prognosis, it is still a serious threat to human health.This study was a analysis of patients of SCAP in the clinical manifestations, common etiology, related drug sensitivity, risk factors, diagnosis and treatment and prognosis, to strengthen awareness of the disease, improve diagnosis and treatment of disease.Methods:Select96patients with severe community-acquired pneumonia (SCAP) in Tianjin Medical University General Hospital Emergency Center treated from March2012to September2013age from32to91years old, mean age (69.8±17.3years), It recorded patient clinical data, vital signs and Carry blood cells checking, CRP,serum procalcitonin (PCT),electrolytes,blood gas analysis, liver function,kidney function on blood taken and radiological and other tests within24hours of admission. Analyzed the patient’s age, gender, underlying diseases, vital signs and laboratory etiological information. Understanding of the distribution of etiology of all SCAP patients. And according to the patient’s prognosis and divided them into death group and survival group, and to compare their observed indicators, multivariate analysis using logistic regression methods for basic information SCAP patients were compared in a meaningful factors into the circulation,To explore the impact of SCAP prognostic risk factors.Results:(1) In96cases SCAP patients included59male cases accounting for61.0%with an average age of70.32±7.57years (32to91years old);37female cases accounting for39.0%with an average age of67.63±6.45years (38to89years old). Among patients18cases of chronic obstructive pulmonary disease (18.75%),15cases of chronic heart failure(13.54%),16cases of cerebrovascular disease (16.67%),7cases neoplastic diseases (7.29%),6cases of chronic liver disease ((6.25%),5cases of chronic renal insufficiency(5.20%),20cases with type2diabetes (20.83%).(2)96cases of SCAP patients, respiratory rate>30beats/min in42cases accounted for40.32%, heart rate>125/min27cases accounted for28.12%, systolic blood pressure <90mmHg13cases accounted for13.54%, fever(>39℃)62cases accounting for64.58%, arterial PH<7.3540cases accounted for41.67%, PaO2<50mm Hg58cases accounted for60.42%, blood WBC>10X109or<4.0X109/L in79cases accounted for82.29%, platelet (PLT)<100X109/L31cases accounted for32.29%, C-reactive protein (CRP) increased87cases accounted for90.63%, PCT rises73cases accounted for76.04%, hyponatremia19cases accounting for of19.79%, hypokalemia21cases accounted for21.88%, serum albumin (ALB)<27g/L35cases accounted for36.46%, BUN>7.1mmol/L46cases accounted for41.92%, multiple lung infiltration89cases accounting for92.70%, pleural effusion59cases accounting for61.46%.(3)96cases of SCAP patients, specific infecting pathogens were identified in54patients and negative in42cases, the positive rate of56.3%. Among them, the pure bacterial culture was positive in38cases, simple atypical pathogens tested positive in11cases,5cases with mixed infection by bacteria and atypical pathogen, illustrating a higher percentage of bacterial infections in patients of SCAP. In48cases of bacterial infection patients, Pseudomonas aeruginosa accounted for13cases (27.1%), Klebsiella pneumoniae9cases (18.8%), Staphylococcus aureus7cases (14.6%), Haemophilus influenzae5patients (10.4%), Acinetobacter baumannii4cases (8.3%), Enterobacter aerogenes3cases (6.3%), Pseudomonas maltophilia3cases (6.3%), Enterobacter cloacae2cases (4.2%), Streptococcus pneumoniae2cases (4.2%); atypical pathogens in16patients, mycoplasma pneumoniae accounted for11cases (68.8%), Chlamydia pneumoniae infection in5cases (31.2%).(4) in96cases of SCAP patients after active comprehensive treatment,47cases improved (49.0%),49patients died (51.0%). Looking relevant prognostic factors SCAP study, we use gender, age, and the worst value of laboratory tests, as well as risk factors as independent variables to establish a multivariate logistic regression model, logistic regression showed among patients with severe community-acquired pneumonia prognostic factors artificial airway,respiratory acidosis, hypoalbuminemia, hyponatremia, age, COPD, cerebrovascular disease is increased in patients with SCAP30d independent risk factor for all-cause mortality (all P<0.05).Conclusions:1.the infection of SCAP with gram-negative bacteria dominated Pseudomonas aeruginosa and Klebsiella pneumoniae are most common pathogens in patients with SCAP,Gram-positive cocci Staphylococcus aureus is the most common, and with community-acquired methicillin-resistant Staphylococcus aureus (CA an MRS A) dominated. Low overall proportion of atypical pathogens, and with mycoplasma infection dominated.2. This study shows that: prognostic impact of SCAP risk factors were artificial airway, respiratory acidosis, hypoalbuminemia, hyponatremia, age, COPD, cerebrovascular disease.