Clinical Features And Prognostic Factors Of Severe Pneumonia In Adults

Objective:Severe pneumonia is currently a high mortality rate,and the prognosis of patients at different ages may vary.Middle-aged and elderly people have different body functions,and the prognosis of elderly patients with severe pneumonia may be worse.This article analyzes the clinical characteristics of patients with severe pneumonia between different ages,and explores the risk factors that affect their prognosis in order to provide individualized diagnosis and treatment programs for clinical and evaluate the prognosis.Methods: Retrospectively collected clinical data of 138 inpatients diagnosed with severe pneumonia and aged> 18 years old from January 1,2016 to December 31,2019 at the Affiliated Hospital of Southwest Medical University,including basic information and laboratory data And imaging information.Grouping: According to the age of patients,52 cases were divided into young and middle-aged group [(18-64)years old] and 86 cases in elderly group(≥65 years old).According to the survival during hospitalization,they were divided into 81 cases in the survival group and 57 cases in the death group.The statistical methods were t-test,chi-square test or Fisher’s exact probability method,Mann-Whitney U test,multi-factor binary classification logistic regression method,ROC curve,etc.Results: A total of 138 adults with severe pneumonia were included in this study,including 105 males(76%)and 33 females(24%).There were 52 cases(37.7%)in the middle-aged group and 86 cases(62.3%)in the elderly group.There were 81 cases(58.7%)in the survival group and 57 cases(41.3%)in the death group.A total of 48 cases(34.78%)of microorganisms were isolated from 138 patients with lower respiratory tract secretions,including 32 cases of bacteria,18 cases of fungi,10 cases of atypical pathogens,and 2 cases of viruses.Analysis of clinical characteristics of patients with severe pneumonia at different ages: hemoglobin,alanine aminotransferase,and aspartate aminotransferase were lower in the elderly group than in the young middle-aged group,while the APACHEII score was higher than that in the young middle-aged group,P value <0.05.Compared with that of the young and middle-aged group,the isolation rate of fungi in the lower respiratory tract secretion was higher in the elderly group,with a P value of <0.05.Among all patients in the survival and death groups,the infection rate of Aspergillus fumigatus was statistically different between the two groups,with a P value of <0.05.Aspergillus fumigatus infection in patients with severe pneumonia may be related to the prognosis of death.Analysis of prognosis-related risk factors in patients of different ages: Among the young and middle-aged patients with severe pneumonia,the AST,FDP,and APACHEII scores in the death group were higher than those in the survival group,and the WBC,NEU,and NLR were lower than those in the survival group.Multivariate logistic regression analysis showed that an elevated APAIICHE score(OR = 1.254)was a risk factor affecting the prognosis of young and severe patients with severe pneumonia.ROC curve analysis showed an AUC of 0.741 and a P value of 0.002.When the APACHEII score was greater than 17,the sensitivity 64.86,specificity 80.00.Among the elderly patients with severe pneumonia,the age,BUN,cTn,D-Di,FDP,and APACHEII scores in the death group were higher than those in the survival group,and the levels of LYM and FIB were lower than those in the survival group.The P value was <0.05.Multivariate logistic regression analysis showed that decreased levels of LYM,FIB and increased levels of age,D-Di,and FDP were high risk factors for patient death.ROC curve analysis showed that the AUC of age was 0.646 and the P value was 0.016.When the age was> 76,the sensitivity was 66.67 and the specificity was 61.36.The AUC of LYM was 0.654 and the P value was 0.011.When the LYM was <0.42,the sensitivity was 42.86.,Specificity 90.91;AUC of D-Di is 0.767,P value <0.001,when D-Di> 3.17,sensitivity 66.67,specificity 84.09;AUC of FIB is 0.635,P value = 0.025,when FIB <6.27,Sensitivity 76.19,specificity 47.73;FDP AUC is 0.761,P value <0.001,when FDP> 10.81,sensitivity 71.43,specificity 77.27.Among them,D-Di has the highest AUC and has better predictive value for patients’ prognosis.Conclusion:(1)The levels of HB,ALT,and AST in the elderly with severe pneumonia were lower than those in the young and middle-aged group,and the APACHEII score was higher than that in the young and middle-aged group.(2)In the young and middle-aged group of patients with severe pneumonia,an elevated APACHEII score is a risk factor for death.In elderly patients with severe pneumonia,LYM and FIB levels are reduced,and age,D-Di,and FDP levels are increased,which are risk factors for patient death.Among them,D-Di has a better predictive value for patient prognosis.(3)Gram-negative bacteria are the main pathogens in adult patients with severe pneumonia.Among them,Bowman hemolytic Acinetobacter is more common.(4)Compared with the young and middle-aged group,the separation rate of fungi was higher in the elderly group.In the death group,the infection rate of aspergillus fumigatus was higher,which was associated with the prognosis.