| BackgroundCommunity acquired pneumonia(CAP)refers to inflammation of the lung parenchyma(including alveolar walls,or interstitial lung in the broad sense)that is contracted outside the hospital,including pneumonia with pathogens with a clear incubation period that develops during the average latency period after admission,CAP is one of the most common infectious diseases that threaten human health.It is the sixth leading cause of death in the world,with high morbidity and mortality in all age groups worldwide,and is one of the major burdens on healthcare resources.The composition and drug resistance of CAP pathogenic agents are obviously different in different countries and regions,and change with the passage of time.Diabetes patients with chronic diseases as a special group,their immune function decline,diabetes itself is easy to cause many complications,increased the risk of infectious disease,infection,the most important reason for diabetes to death,the morbidity and mortality of community acquired pneumonia in diabetes mellitus were significantly higher than patients without diabetes.Objective:This study was aimed to understand the pathogens of community-acquired pneumonia(CAP)complicated with diabetes mellitus(DM)so as to guide the anti-infection treatment for CAP complicated with DM in Pingdingshan.Meanwhile,the prognostic factors were analyzed to help doctors judge the condition of patients with CAP and DM,and evaluate the prognosis.Methods:One hundred patients with CAP and DM treated in the department of respiratory medicine and department of endocrinology in Pingdingshan First People’s Hospital between 2017 01.01 and 2018 12.31 were selected as the DM-CAP group.Meanwhile,100 patients with CAP but without DM were selected as the non-DM-CAP group.Clinical data and laboratory indicators were collected.Pathogen strains isolated from clinical specimens of patients enrolled were collected after admission for pathogen culture,and the detection of pathogen was recorded.The clinical data,laboratory indicators,pathogens and treatment of the two groups were compared.The variables with differences after univariate analysis were included in Logistic stepwise regression analysis to identify the influencing factors of poor prognosis of CAP,and a risk prediction model for poor prognosis of CAP was constructed based on Logistic stepwise regression analysis.Hosmer-Lemeshow test was conducted,and receiver operating characteristic(ROC)curve was plotted to analyze the prediction efficiency of this model.Results:1、There were 36 pathogen-positive cases(36.00%)and 29 pathogen-positive cases(29.00%)in the DM-CAP group and the non-DM-CAP group,respectively.There was no significant difference in the detection rate of pathogens between the two groups(x2=1.116,P=0.290).A total of 36 strains of pathogenic bacteria were detected in the DM-CAP group,all of which were single infection,and the detection rate of Escherichia coli was the highest.29 strains of pathogenic bacteria were detected in the non-DM-CAP group,all of which were single infection,and the detection rate of Streptococcus pneumoniae was the highest.Compared with the non-DM-CAP group,the common pathogenic bacteria of DM-CAP group included Gbacilli and fungi additionally.2、Gender,chronic cerebrovascular disease,chronic obstructive pulmonary disease,chronic liver disease,chronic kidney disease,disturbance of consciousness,systolic blood pressure<90mmHg,hemoglobin level<100g/L,serum albumin level<35g/L,arterial oxygenation index<300mmHg,multiple lobe-segment infiltration,pleural effusion,white blood cells(WBC),neutrophils(NE),blood platelet(PLT),erythrocyte sedimentation rate(ESR),alanine aminotransferase(ALT),aspartate aminotransferase(AST),and albumin(ALB)showed no statistically significant difference between the DM-CAP group and the non-DM-CAP group(P>0.05).However,there were statistically significant differences in age,respiratory rate ≥30 times/min,blood urea nitrogen>7mmol/L and blood glucose at admission.C-reactive protein(CRP),procalcitonin(PCT),brain natriuretic peptide(BNP),creatinine(Cr)and blood urea nitrogen(BUN)in the DM-CAP group were significantly higher than those in the non-DM-CAP group,while partial pressure of oxygen(PO2),partial pressure of carbon dioxide(PCO2),CD3+,CD4+,CD8+ and CD4+/CD8+were significantly lower than those in the non-DM-CAP group(P<0.05).3、There was no significant difference in hospital mortality between the DM-CAP group and the non-DM-CAP group(P>0.05).The length of hospital stay,proportions of respiratory failure,bacteremia and transfer to ICU,and PSI score of the DM-CAP group were significantly higher than those of the non-DM-CAP group.The proportion of initial treatment failure in the DM-CAP group was significantly higher than that in the non-DM-CAP group(P<0.05).4、Logistic stepwise regression analysis showed that age,DM,CRP,PCT,BNP,Cr,BUN,CD4+and invasive mechanical ventilation were risk factors for poor prognosis of patients with CAP(P<0.05),all variance inflation factor(VIF)<3.5、The risk prediction model of poor prognosis of CAP constructed based on Logistic stepwise regression analysis showed good goodness of fit.The area under the curve(AUC)of the risk prediction model was 0.916(0.869-0.954),Z=13.487,P<0.001,and Yoden index was 0.737.Taking 0.232 as the critical value,the sensitivity and specificity of the risk prediction model for poor prognosis of CAP were 81.08%and 92.64%,respectively.Conclusion:Compared with patients with CAP but without DM,In clinical practice,attention should also be paid to G-bacillus and fungal infections in patients with DM-CAP patients with CAP and DM are older,in more serious condition,with higher blood glucose level,worse immune function and higher initial treatment failure rate.Age,CRP,PCT,BNP,Cr,BUN,and invasive mechanical ventilation were risk factors for poor prognosis of patients with CAP and DM.The prognostic risk prediction model of CAP constructed based on Logistic stepwise regression analysis is with high specificity in predicting poor prognosis of CAP. |
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