A Retrospective Study To Analyze The Indicators Used To Assess The Condition And Prognosis Of Severe H1N1 Influenza Pneumonia

Objective:To analyze clinical indexes which can be used in evaluating the prognosis of severe H1N1 influenza pneumonia.Meanwhile,to summarize the common clinical indicators that have correlation with the severity of severe H1N1 influenza pneumonia.Methods:We carried out a retrospective review on the clinical data of 70 patients hospitalized with severe H1N1 influenza pneumonia in the First Hospital of Jilin University from April 2017 to May 2019.General information,laboratory serological and microbiological indices,imaging data and referrals were collected from the enrolled patients,and the worst APACHE II(Acute Physiology and Chronic Health Evaluation II)score and SOFA(Sequential Organ Failure Assessment)score within 24 hours of patient admission were calculated.All patients were divided into high-risk and low-risk groups according to the APACHE II score and SOFA score within 24 hours of admission,into survival and death groups according to their 28-day survival,and into combined bacterial infection and uncomplicated bacterial infection groups based on whether they were combined with bacterial infection during hospitalization.We used SPSS 23.0 to analyze the serological indicators that were statistically different between the high-risk and low-risk groups of patients at admission.Then we summarized the indicators that had predictive value for patients with or without combined bacterial infections during the course of the disease.At last,we compared the data of patients in the surviving and deceased groups,and we used multifactorial binary logistic regression analysis to screen the independent high-risk factors for death in patients with severe H1N1 influenza pneumonia,and multifactorial combined diagnosis receiver-operating characteristic curve(ROC)was plotted to further assess the sensitivity and specificity of each indicator in predicting the risk of death in patients with severe H1N1 influenza pneumonia.Results:1.Comparison of general information:There were no statistical differences in age,gender,smoking history and coexisting diseases between the surviving and dying groups,between the high-risk and low-risk groups and between the combined bacterial infection and non-combined bacterial infection groups(P>0.05).2.Related to the prognosis:(1)There was no significant difference in CRP(C-reactive protein)between survival and fatal groups(P>0.05).However,NLR(Neutrophil-to-lymphocyte Ratio),PCT(Procalcitonin)levels,IL-10(Interleukin 10)levels,SOFA score,APACHEII score and DLP(duration of lymphocytopenia)in the fatal group were higher than those in survival group(P<0.05).(2)The results of binary logistic regression analysis showed that NLR and DLP were independent risk factors affecting the prognosis of patients with severe H1N1 influenza pneumonia(P < 0.05).(3)We plotted the ROC curve of independent risk factors affecting the prognosis of patients with severe H1N1 influenza pneumonia,and the results showed that NLR had the largest area under the curve(AUC of 0.705),followed by DLP(AUC of0.695).Multifactorial combined diagnosis receiver-operating characteristic curve(ROC)suggested that NLR combined with DLP could better predicte the risk of death in patients with severe H1N1 influenza pneumonia than single factor.They had a larger area under the curve(AUC of 0.787),and the sensitivity(60%)and specificity(90%)were better.3.Related to the co-infection with bacteria during the course of the disease:There were no significant differences in the level of NLR,PCT and CRP on admission between the groups combined with or without bacterial infection(P > 0.05),indicating that hematological indicators such as NLR had no value in assessing the risk of combined bacterial infection in patients with severe H1N1 influenza pneumonia.4.Related to the severity of disease:ALL the patients were divided into high-risk and low-risk groups according to the worst APACHE II score and SOFA score within 24 hours from their hospitalization,and the CRP and PCT levels in the high-risk group were significantly higher than those in the low-risk group(P < 0.05),suggesting that the levels of PCT and CRP on admission were positively correlated with the severity of severe H1N1 influenza pneumonia.Conclusions:1.NLR and DLP were independent risk factors in severe H1N1 influenza pneumonia.2.Combination of NLR and DLP had better predictive value for patients’ prognosis.3.The levels of CRP and PCT of patients with severe H1N1 influenza pneumonia on their admission were positively correlated with the severity of their illness.