Independent Risk Factors For Prognosis In Patients With Pulmonary Sepsis

BackgroundSepsis is a multiple organ dysfunction caused by a dysregulated host response to infection,and is one of the main causes of death in patients admitted to intensive care units.With the deepening of people’s understanding of sepsis,the mortality of patients with sepsis has decreased compared with before,but the mortality is still at a high level.In the sepsis subgroup,pulmonary sepsis was characterized by high mortality and high morbidity compared with other sepsis subgroups.Previous studies on the prognostic risk factors of sepsis were based on the whole,and there were too few studies on the subgroup of pulmonary sepsis.Therefore,there is an urgent need to explore related risk factors to help clinicians identify high-risk patients with pulmonary sepsis,in order to give individualized intervention to patients with pulmonary sepsis,so as to reduce mortality.Objective1.To clarify the incidence,general characteristics,underlying diseases,some laboratory indicators and clinical prognosis of patients with pulmonary sepsis.2.The relevant risk factors for patients with pulmonary sepsis were screened out by univariate analysis,and the independent risk factors for 28-day mortality were further screened out by binary Logistic regression analysis.MethodUse SQL statements to obtain the target population data in the MIMIC-Ⅳ database.According to the inclusion and exclusion criteria,the data of patients with pulmonary sepsis were collected,sorted,screened,and interpolated by Stata software.Shock and other groups,compare the differences between groups.According to the 28-day prognosis of patients with pulmonary sepsis,they were divided into survival group and death group.Stata software was used to conduct univariate and binary Logistic regression analysis to determine the independent risk factors affecting the death of patients with different subtypes of pulmonary sepsis.Results1.A total of 21410 patients with sepsis were enrolled in this study,of which 3349patients were diagnosed with pulmonary sepsis.Pulmonary sepsis was more common in male patients（2052,61.27%）,and was younger than non-pulmonary sepsis patients（62.15±16.70 VS 65.48±16.07,P<0.001）.There was no significant difference in weight between patients with non-pulmonary sepsis and patients with sepsis（84.31±25.57 VS84.31±25.57,P>0.05）.Patients with pulmonary sepsis and non-pulmonary sepsis were compared in terms of general conditions（Sex,Weight）,underlying diseases（Chronic obstructive pulmonary disease,Heart failure,Liver disease）,vital signs（HR,RR,T,Glu）,laboratory indicators(HCT,HB,PLT,WBC,BUN,SCR,APTT,PO₂,PCO₂,Ca²⁺,Cl^-,Na⁺,K⁺,BE,AG),intervention measures（Invasive ventilation,Norepinephrine,Continuous renal replacement therapy）,disease prognosis scores（SOFA score,SAPS II score,LODS score）and prognosis indicators（ICU stays,hospital stays,28-day mortality rate）were statistically different（P<0.05）.In addition,Kaplan-Meier survival analysis showed that the overall survival rate of patients with pulmonary sepsis was lower than that of patients with extrapulmonary sepsis（P<0.05）.2.In a subgroup study of patients with pulmonary sepsis,It was found that there were statistically significant differences in general conditions（Gender,Age）,vital signs（RR）,laboratory indicators(HCT,HB,PO₂,Ca²⁺,LAC),intervention treatment（Norepinephrine）,and prognostic indicators（ICU days,hospital stays）between patients with Gram-negative bacteria and patients with Gram-positive bacteria in pulmonary sepsis（P<0.05）.However,there was no significant difference in 28-day mortality between the two groups（23.64%VS 22.03%,P>0.05）.In addition,Kaplan-Meier survival analysis showed that there was no significant difference in overall survival rate between patients with Gram-negative bacteria and patients with Gram-positive bacteria（P>0.05）.3.In a subgroup study of patients with pulmonary sepsis,It was found that the general conditions（Age,Weight）,Combined underlying diseases（Chronic obstructive pulmonary disease,Heart failure,Liver disease）,vital signs（HR,MAP,RR,T,Sp O₂,Glu）and laboratory indicators(WBC,BUN,SCR,INR,PT,APTT,PO₂,PCO₂,Ca²⁺,Cl^-,Na⁺,K⁺,BE,AG,LAC),intervention measures（Invasive ventilation,Norepinephrine,Continuous renal replacement therapy）,Disease prognosis score（SOFA score,SAPS II score,LODS score）and prognostic indicators（ICU days,hospital stays,and 28-day mortality）were statistically different（P<0.05）.4.Univariate analysis of patients with severe respiratory dysfunction caused by pulmonary sepsis showed that:Age,Weight,Hypertension,Glu,HB,PLT,BUN,INR,PT,APTT,PO₂,Ca²⁺,BE,AG,LAC,Norepinephrine,Continuous renal replacement therapy,SOFA score,SAPS II score,LODS score and other factors were associated with severe respiratory function in patients with pulmonary sepsis the 28-day mortality relationship was significant in patients with disorders.5.In a subgroup study of patients with pulmonary sepsis,It was found that there were significant differences in general conditions（Age,Weight）,combined basic diseases（Hypertension,Liver disease）,vital signs（T,Glu）,laboratory indicators（PLT,WBC,BUN,SCR,INR,PT,APTT,PO₂,K⁺,BE,AG,LAC）,intervention measures（Invasive ventilation）between patients with pulmonary sepsis shock group and non-shock group（Norepinephrine,Continuous renal replacement therapy）,disease prognosis scores（SOFA score,SAPS II score,LODS score）and prognostic indicators（ICU stays,hospital stays,28-day mortality）were statistically different（P<0.05）.6.Univariate analysis showed that Gender,Age,Weight,Hypertension,T,BUN,PCO₂,Ca²⁺,Na⁺,SAPS II score and LODS score were significantly associated with 28-day mortality in patients with pulmonary septic shock.7.Univariate analysis showed that Gender,Age,Weight,Hypertension,T,BUN,PCO₂,Ca²⁺,Na⁺,SAPS II score and LODS score were significantly associated with 28-day mortality in patients with pulmonary septic shock.Conclusion1.The 28-day mortality of patients with pulmonary sepsis is higher than that of patients with extrapulmonary sepsis,and most of them have chronic underlying diseases.The overall survival rate of patients with pulmonary sepsis is lower than that of non-pulmonary sepsis.2.There was no significant difference in 28-day mortality between patients with Gram-negative bacteria and those with Gram-positive bacteria in patients with pulmonary sepsis,and there was no significant difference in overall survival between the two groups.3.Older,Low weight,Hypertension,High BE,High AG,Renal replacement therapy and use of Norepinephrine predict poor prognosis in patients with severe respiratory dysfunction caused by pulmonary sepsis.4.Older,Hypothermia,Hypertension,and High Ca²⁺can predict poor prognosis in patients with pulmonary septic shock.