Analysis And Evaluation Of Early Prognostic Factors Of Mortality In Patients With Severe Community Acquired Pneumonia

Objective:To analyze the risk factors influencing the prognosis of patients with SCAP(comorbidities,age,PCT,PT,D-d,blood urea,SMART-COP score,SOFA score),the 28-day mortality rate of patients with SCAP was predicted and evaluated early and accurately,in order to provide evidence for better clinical treatment and reduction of mortality.Methods:The diagnostic criteria of Department of Pulmonary and Critical Care Medicine,Emergency Department,Department of Intensive Medicine,and Geriatrics Department in the First Hospital of Shanxi Medical University were taken as the object of study(2014.10-2018.9),collect demography,radiology and laboratory data from all patients.Calculate SMART-COP score and SOFA score according to the code of points.The patients were divided into death group and survival group according to the outcome of 28 days' death or survival.Retrospective case comparative study and logistic regression analysis were used to predict and evaluate the risk of recent mortality in patients with SCAP.The area under the curve of SMART-COP score and SOFA score was calculated by drawing ROC curve.Results:Of the 137 SCAP patients who met the criteria,53(38.7%)survived and 84(61.3%)died.There were 73(53.3%)males and 45 died,64 females(46.7%)and 39 died(P>0.05).The pathogenic results showed that 46(33.6%)patients had no pathogenic bacteria,the highest positive rate was found in 17 influenza viruses(12.4%),of which 11 were influenza B viruses and 6 were influenza A viruses.There was statistical significance between renal insufficiency and type 2 diabetes in comorbidities(P > 0.05).The prognostic factors of recent mortality in patients with SCAP was related to age,PCT,PT,D-d,blood urea,SMART-COP score,SOFA score.The age,PCT,PT,D-d,blood urea,SMART-COP score and SOFA score of SCAP patients with different outcomes were statistically significant,and the outcome of death group was higher than that of survival group(P>0.05).Multivariate analysis showed that the older the patients were,the higher level of PCT,PT,blood urea was,and the worse the prognosis of the patients was.For every 1 point increase in the SMART-COP score,the risk of death increased by 0.897 times.Conclusion:The incidence of SCAP in patients with CAP was 12.7%,and the mortality rate was61.3%.There was no significant effect of sex on mortality of patients with SCAP.In the past,SCAP patients with renal insufficiency and type 2 diabetes had poor prognosis.The older the SCAP patients were,the worse the prognosis was.The higher value of PCT,PT,D-d,blood urea,the worse the prognosis of SCAP patients were.The worse the prognosis of SCAP patients were,when SMART-COP score ? 3.The higher the SOFA score was,the worse the prognosis of SCAP patients were.