| Objective: In order to further explore the risk factors affecting the prognosis of severe community acquired pneumonia to identify high-risk patients at an early stage,our study try to find a simple and easily available laboratory index,analyze and summarize the TCM syndromes and characteristics of severe pneumonia which aim to provide some reference for the treatment of severe pneumonia with the combination of traditional Chinese and Western medicine.Methods:In this retrospective analysis,157 cases of severe pneumonia patients from January 2016 to December 2018 were collected from the respiratory department of the Affiliated Hospital of traditional Chinese medicine of Southwest Medical University.According to the treatment results,they were divided into death group and survival group.The general data,clinical symptoms,relevant laboratory indicators,TCM Syndrome Distribution and other data of the patients were collected and the database was established for analysis.SPSS17.0 software was used for statistical analysis in this study.The mean plus or minus the standard deviation was used for measurement data according with normal distribution,or used of Median(interquartile rang)represented the measurement data of unaccording with the normal distribution.Frequency and rate(%)or the proportion(%)was used for the count data.Among them,quantitative data conforming to the normal distribution and having the same variance are used for comparison between the two groups,t-test is used for comparison,and rank sum test is used for quantitative data of unnormal distribution;chi-square test or Fisher exact probability method is used for comparison between two or more constituent ratios.Correlation analysis was used to analyze the relationship between the two factors,among which Pearson correlation analysis was used to analyze the continuous data,which was consistent with the normal distribution.When one or two variables do not obey the normal distribution,such as grade data or classification data,Spearman correlation analysis was used.Draw the area under ROC curve,calculate the critical value,sensitivity,specificity and other evaluation indexes,evaluate and analyze the prediction and prognosis value of each index of severe pneumonia patients.The logistic regression model of severe pneumonia was made to explore the predictive factors that may affect the prognosis of severe pneumonia.All the above results were tested bilaterally,P<0.05 was statistically significant.Results:A total of 157 patients with severe pneumonia were included in this study,including 52 in the death group and 105 in the survival group.The study found that:1.There were statistically significant differences between the two groups in age of onset,length of stay,respiratory support after admission and the number of people admitted to ICU(P<0.05),but no statistical differences in gender,smoking history,type of respiratory failure.2.There were significant differences in UA,LAC,D-dimer and RDW between the two groups(P<0.01).3.The area under curve of the ROC for predicting the death risk of SCAP is 0.765,and the 95%CI is 0.682? 0.849,The sensitivity is 0.615,the specificity is 0.838,the +LR is 3.80,the-LR is 0.46,P<0.01,and the optimal cutoff value is 440.5?mol/L based on the yoden index;the area under the curve of lactate is 0.668,95%CI:0.579?0.757,the sensitivity is 0.769,the specificity is 0.467,and the +LR is 1.44,-LR is 0.49,P<0.01,and the best truncation value is 2.015mmol/L;under curve area of RDW is 0.673,95% CI:0.587?0.758,sensitivity is 0.712,specificity is 0.590,+LR is1.74,-LR is 0.49,P<0.01,and the best truncation value is 14.75%;under curve area of D-dimer is 0.621,95%CI: 0.528?0.714,sensitivity is 0.654,specificity is 0.571,+LR is 1.52,-LR is 0.61,P=0.014,and the best cutoff value is 1.37?g/L.4.According to the area under ROC curve to obtain the best cutoff value,the logistic regression model found that patients with UA ? 440.5?mol/L had a higher risk of death than patients with UA<440.5?mol/L;patients with LAC?2.015 mmol/L were more likely to have a risk of death than patients with LAC<2.015mmol/L;patients with RDW?14.75% are more likely to have a risk of death than patients with RDW<14.75%.5.Distribution of TCM disease and TCM Syndrome Type: the disease classification of 157 cases of severe pneumonia is mostly based on empirical evidence,the death group has more deficiency syndrome and critical syndrome.The syndrome of phlegm heat damming the lung is the most common type;In the death group,deficiency of lung qi and spleen qi and deficiency of Qi and Yin were common,and the syndrome of Qi Yin deficiency in the survival group was more than that of lung qi and spleen qi deficiency,and the syndrome of heat depression in the pericardium was more than that of Qi Yin deficiency in the survival group.There was significant difference between the two groups.6.TCM syndrome types and age distribution:157 patients with severe pneumonia were divided into young group(? 44years),middle-aged group(45?64years),and elderly group(?65years)according to age.There were statistics differences on age and TCM syndrome types:In the young group,the syndrome type is relatively single,mainly based on empirical evidence,and the most common is phlegm heat damming lung syndrome;in the middle-aged group,there are both empirical and deficiency syndromes;in the old group,the disease is relatively complex,the syndrome type is more diversified,and the most likely to appear critical syndrome.Conclusion: 1.The higher the level of uric acid,lactate and RDW,the higher the risk of death.Uric acid,lactate and RDW are important for the early identification of death risk of severe pneumonia.We should pay attention to the patients with severe pneumonia whose levels of uric acid,lactic acid and RDW are increased.Early intervention may be more beneficial to the treatment and prognosis of patients with severe pneumonia.2.In the aspect of TCM pathogenicity: the prognosis of patients with severe pneumonia is related to the pathogenicity of TCM.The patients with deficiency syndrome and critical syndrome have poor prognosis.In the aspect of TCM Syndrome Type: phlegm heat damming lung syndrome is still the most common TCM syndrome type of severe pneumonia.Patients with both lung and spleen Qi deficiency syndrome and Qi and Yin deficiency syndrome may have a poor prognosis.The prognosis of the patients with the syndrome of pathogenic depression and positive detachment may be worse than that of the patients with the syndrome of heat depression and pericardium. |
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