Analysis Of The Characteristics Of Immunological And Infective Indexes Of Patients With CAP In RICU

Objective:To study the characteristics of immunological and infective indexes of hospitalized patients with community-acquired pneumonia(CAP)in RICU and analyze the correlation between immunological and infective indexes and the correlation between these indexes and the prognosis of the patients with CAP.Objects and methods:The clinical data of patients diagnosed as CAP admitted to department of respiratory and critical care medicine of the First Hospital of Jilin University from September 2017 to February 2019 were retrospectively analyzed.First,the patients were divided into survival group and death group according to the according to the mortality at discharge and 28-day survival after hospital discharge;Second,they were divided into virus infection group,bacterial infection group and mixed infection group according to pathogen results at admission,and they were divided into extracellular pathogen infection group,intracellular pathogen infection group and extracellular pathogen combined with intracellular pathogen infection group according to the pathogenesis of pathogens.The differences of general clinical characteristics,prognosis,the length of hospital stay,CD3~+T cell count,CD4~+T cell count,CD8~+T cell count,PCT,CRP among groups were analyzed by statistical method.Logistic regression model was used to analyze the risk factors of patients in non-survival group.Result:1.94 patients were finally enrolled,60 of whom were survived,and34 dead.Among patients with pathogen results,21 as virus infection(22.83%),52 as bacterial infection(56.52%),19 with mixed infection(20.65%);43 with extracellular pathogen infection(45.74%),25with intracellular pathogen infection(26.60%),26 with mixed infection(27.66%).The CD3~+T cell count,CD4~+T cell count and CD8~+T cell count of most patients with CAP were reduced.2.Compared patients with different outcomes,the total amount of leukocyte,neutrophil count,PCT,CRP of the survival group were significantly lower than those of the death group,but the CD3~+T cell count,CD4~+T cell count and CD8~+T cell count of the survival group were significantly higher than that those of the death group,and there was statistically significant difference(all P<0.05).The erythrocyte sedimentation rate of the survival group were lower than that of the death group,but the difference was not statistically significant(all P>0.05).3.Logistic regression analysis showed that CD3~+T cell count,CD4~+T cell count,CD8~+T cell count,PCT,neutrophil count and the total amount of leukocyte were independent risk factors for death in CAP patients(all P<0.05).4.Comparing patients infected with different pathogens,the age and CD3~+T cell count of the virus infection group patients were significantly lower than that of bacterial infection group patients(all P<0.05),but the level of Cr were significantly higher in virus infection group compared with bacterial infection group(P<0.05).The CD4~+T cell count and CD8~+T cell count of the virus infection group patients were lower than that of bacterial infection group patients,but the difference was not statistically significant(all P>0.05).The two group had no significant difference in gender composition,the length of hospital stay,the total amount of leukocyte,Cr,D-Dimer and prognosis(all P>0.05).5.The age of the intracellular pathogen infection group patients were significantly lower than that of extracellular pathogen infection group patients(P<0.05),but the level of Cr were higher in intracellular pathogen infection group compared with extracellular pathogen infection group.Compared with the intracellular bacterial infection group,the CD3~+T cell count,CD4~+T cell count and CD8~+T cell count were significantly increased in the extracellular pathogen infection group(all P<0.05).The two group had no significant difference in gender composition,the length of hospital stay,the total amount of leukocyte,Cr,D-Dimer and prognosis(all P>0.05).Conclusion:1.The total amount of leukocyte,neutrophil count,CD3~+T cell count CD4~+T cell count,CD8~+T cell count and PCT were independent risk factors for patients.2.The intracellular bacterial infection was more likely to cause the decrease of CD3~+T cell count,CD4~+T cell count and CD8~+T cell count than the extracellular bacterial.3.Patients with simple viral infection may have more severe kidney damage than those with simple bacterial infection.