Analysis Of Clinical Characteristics And Risk Factors Of Death With Severe Pneumonia After Renal Transplantation

BackgroundWith the development of technology for organ transplantation,renal transplantation has become one of the most effective method for the treatment of end-stage renal failure.In order to inhibit rejection after renal transplantation,the patients need to take large doses of immunosuppressants for a long time,which can induce the body's cellular immunity and humoral immunity being attacked.The organism in lower immunity is easy to occur a variety of pathogenic bacteria infection,while the lung infection is the most common.The patients with pulmonary infection after renal transplantation are different from the ordinary patients with lung infection.Because of the poor immunity of these patients after renal transplantation,pulmonary infection has the characteristics of rapid onset and progress,which can develop into severe pneumonia easily and fatally.This study was focused on the clinical characteristics and risk factors of death in patients with severe pneumonia after renal transplantation,in order to improve the cognition of this disease,which was conducive to the adjustment of clinical treatment to improve the level of clinical diagnosis and treatment and reduce the mortality of severe pneumonia after renal transplantation.ObjectiveTo analyze and summarize the clinical characteristics of severe pneumonia after renal transplantation,to explore the risk factors of death for this disease.To provide reference for the clinical diagnosis and treatment of severe pneumonia after renal transplantation.MethodsSixty-five patients with severe pneumonia after renal transplantation admitted to the First Affiliated Hospital of Zhengzhou University from January 2014 to December 2017 were retrospectively analyzed.According to the discharge outcome,the patients were divided into two groups,named Group death and Group survival.By comparing with the clinical data of the two groups,the related risk factors of death for severe pneumonia after renal transplantation were analyzed,and the independent risk factors of death were analyzed further.ROC curve was drawn for the independent risk factors,and the optimal cutoff point,sensitivity and specificity of each index were obtained.All the data were analyzed by SPSS 21.0 software.Select P<0.05 as statistical difference.Results1.The mean age of 65 patients with severe pneumonia after renal transplantation was(38.4±8.7)years old,including 55 males and 10 females.The ratio of male to female was 5.5: 1.Of all the patients,36 cases had a smoke and 14 cases had diabetes.In 65 cases,42 cases(64.61%)of severe pneumonia after renal transplantation were infected between 2 and 6 months,and 61 cases(93.84%)occurred one year after the operation.52 patients(80.00%)had a fever,while the moderate fever(48.08 %)and high fever(25.00 %)were common.Pathogenic bacteria was detected 36 samples,of which bacteria was the most common(66.67 %).Diffuse ground glass-like density shadow(69.23 %)and patchy high density shadow(60.00 %)were common in chest CT.There were 39 cases in the survival group and 26 cases in the death group.It was no significant difference in age,sex,smoking,diabetes between the two groups(P> 0.05).2.Univariate analysis showed that there were statistically significant differences in preventive use of ganciclovir,hemoglobin,D-Dimer,APACHE II and combined shock between the survival group and the death group(P< 0.05).3.Multivariate logistic regression analysis showed that D-Dimer(OR=7.449,P=0.004)and APACHE II score(OR=1.254,P=0.013)were the independent risk factors associated with death for severe pneumonia after renal transplantation.4.ROC curve analysis showed that the best cut off point of D-Dimer was 1.35 mg/L.When the value of D-Dimer was more than 1.35 mg/L,it suggested the patient might have a bad prognosis.The best cutoff point of APACHE II score was 21.5.When the score was more than 21.5,it suggested that there might be a poor prognosis.Conclusions1.Severe pneumonia often occurs in one year after renal transplantation,especially between 2 and 6 months.The fever as the first manifestation is more common,and mostly moderate or high fever.Bacteria is the most common pathogens detected.Chest CT usually shows multiple inflammation shadow in the double lungs.2.The mortality of severe pneumonia after renal transplantation is high and the prognosis is poor.The high value of D-Dimer and APACHE II are the independent risk factors for death for severe pneumonia after renal transplantation.The mortality of severe pneumonia after renal transplantation may be reduced by increasing vigilance and taking appropriate preventive and therapeutic measures in time for the patients with high risk factors.