Real-World Analysis 0F Ulinastatin In The Treatment Of Severe Pneumonia

Objective: To analyze and discuss the epidemiological characteristics,clinical drug characteristics,comorbidities,types of complications and risk factors of severe pneumonia,and to provide reference for clinical rational use of drugs;to evaluate the efficacy and safety of ulinastatin in the treatment of severe pneumonia diseases based on real-world evidence;to supplement the real-world evidence of efficacy and safety of ulinastatin in the treatment of severe pneumonia by comparing the relationship between ulinastatin treatment and clinical outcomes in different age structures,length of hospitalization,compli-cated diseases and combined use of drug.Methods: 1.Literature study method: This paper searches the latest diagnosis and treatment guidelines for severe pneumonia,basic research and clinical research literature of ulinastatin,in order to familiar with the epidemiological characteristics of severe pneumonia and the mechanism and the clinical application of ulinastatin.2.Empirical research: Based on the third-party database of the Chinese Hospital Pharmacovigilance System(CHPS),this paper collects and sorts out the diagnosis and treatment information of patients in two large-scale first-class hospitals in Guangzhou who are admitted to the hospital or admitted to ICU for severe pneumonia in the past year,including the basic information of patients,vital signs data,laboratory test data,diagnostic information,doctor's advice information,etc..After the desensitization and structured treatment,these data are input to SPSS 22.0 statistical analysis software,and then the descriptive statistical analysis,chi-square test,independent sample T Test,paired sample T test,binary logistic regression analysis,multivariate logistic regression analysis and propensity score matching are performed to obtain the information on population characteristics,complications and complications,drug use,etiological examination and antibiotic use,independent risk factors for disease,and the difference between the ulinastatin treatment group and the routine treatment group in clinical outcome,complications,hospitalization time,ventilator time and the rate of improvement and vice-occurrence of clinical test indexes.Results:(1)Clinical characteristics of the disease: Patients with severe pneumonia have significant aging and childhood characteristics,and the prognosis of patients with severe pneumonia is poor,with high mortality and long hospital stay;hypertension,cardiac insufficiency,diabetes,shock(including septic shock and hypovolemic shock),renal insufficiency,hypoproteinemia are the most common complications,and acute kidney injury,septic shock,diffuse intravascular coagulation and multiple organ dysfunction syndrome are the most common neopathy;carbapenems,semisynthetic penicillins,third-generation cephalosporins,and the antifungal vorico-nazole are the most clinically used antibiotics;the overall detection rate of pathogenic pathogens in blood culture/sputum culture is 62.22%.Acinetobacter baumannii,stenotrophomonas maltophilia,aspergillus,and candida albicans are the most common pathogenic microorganisms in clinical practice;multivariate logistic regression analysis shows that epinephrine,correction of acidosis,antiarrhythmias,complications and high C-reactive protein levels are independent risk factors for the clinical outcome of severe pneumonia.(2)Drug evaluation: There is significant difference in mortality and improvement rate between the ulinastatin group and the routine treatment group under the condition of unbalanced confounding factor interference.However,there is no significant difference between the two groups in the clinical outcomes and the incidence of complications,the length of hospitalization and the duration of ventilator after the interference of confounding factors is excluded by the propensity score matching.In subgroup analysis,the mortality rate in the lower age group is lower than that in the older age group;the ulinastatin treatment group has higher disease improvement rate and lower complication rate than the routine treatment group.In the subgroup analysis of staying in hospital longer than 14 days,combined with cardiovascular disease,not combined with multiple organ dysfunction syndrome,and not using epinephrine,the clinical outcome that get better and go home of ulinastatin treatment group is significantly better than that of the routine treatment group(P<0.05).In addition,the improvement rate of clinical outcome and the incidence of complications also indicate that the ulinastatin treatment group has better clinical advantages in these subgroups.Conclusion: Severe pneumonia is an acute illness with a high risk of death.Shock,arrhythmia,acidosis,high CRP levels and complications will increase the risk of death or against-advise discharge.The ulinastatin group has higher disease improvement rate and lower complication rate compared with the routine treatment group.No significant difference is found in the safety test,suggesting that ulinastatin has a good efficacy and safety in the treatment of severe pneumonia.