A Retrospective Analysis Of Clinical Features And Prognostic Factors Of ICU Patients With Severe Community Acquired Pneumonia And Establishment Of Prediction Model

Background and 0bjective: Severe community acquired pneumonia is common in critically ill patients in ICU. In recent years, despite the continued emergence of new broad-spectrum antibiotics, monitoring technology and organ function support technology is also rising, as the aging population, reduced function of host defense, changes in pathogens and the rise of antibiotic resistance, SCAP is still a difficult diseases with high incidence, high mortality and high cost. How to reduce its mortality and improve prognosis, is always a clinician to be one of the severe challenges facing. Therefore, the objective and accurate assessment of prognostic factors in patients with SCAP, analyze and summarize the etiology, status of clinical diagnosis and treatment, will help to understand the development trend of the disease and prognosis, for clinicians to determine the patient's condition and prognosis and to develop reasonable treatment programs for reference. Practice. This study was retrospective analysis of patients with SCAP in our hospital ICU in the clinical characteristics, common pathogens and prognostic factors, to analyze the independent prognostic risk factors of SCAP.Methods: A retrospective case-control study, collected from March 2009 to June 2010 ICU patients'data in the clinical diagnosis of SCAP of the Second Affiliated Hospital of Guangzhou Medical College, which were divided into case groups(death group) and control group (survival group) according to their prognosis,and to analyze the risk factors, clinical features, diagnosis and etiological type of situation, the use of Logistic regression, plans to establish the prognosis of patients with SCAP assessment classification equation.Results:March 2009 to June 2010 in our hospital ICU discharge diagnosis of pneumonia (age≥18 years) of 102 cases of severe pneumonia cases met the diagnostic criteria, selected patients with severe community-acquired pneumonia in 70 cases, 40 cases of death, mortality 57.1%. 3 cases of them died within 24 hours into the ICU, 2 patients discharged in 24 hours into the ICU,6 Cases discharged cured, univariate analysis included 59 cases of patients, male 39 cases, accounting for 66.1%, female 20 cases, accounting for 33.9%, age from 19 to 91 years old, mean age 68.80±17.45 years, with a median age of 75. The average length of hospital stay 26.86±22.47 days, the shortest 4 days, the longest 106 days, median 21 days, of which 21 patients survived, 38 patients died, APACHEⅡ(acute physiology and chronic health evaluationⅡ)score an average of 25.86±6.83 points. 54 cases of patients with mechanical ventilation, minimum 1 day, up to 100 days, with a median of 10 days. 45 patients with positive sputum bacterial culture (76.3%), 26 cases with 2 or more than 2 kinds of bacterial infections (accounting for 57.8% of positive sputum culture), 13 cases of fungal infections (accounting for 28.9% of positive sputum culture). Sputum cultures were isolated 84 strains of bacteria, 14 strains of fungi, 17 strains of gram-positive bacteria, 0.2%), Gram-negative bacteria 67 (79.8%).Acinetobacter baumannii in all Gram-negative bacteria were detected in the highest rate (28.8%), followed by Pseudomonas aeruginosa (18.8%), the gram-positive bacteria, Staphylococcus aureus detection was the highest (64.23%), 66.7% resistant, multi-drug resistant Acinetobacter baumannii in (MDR-Ab) the highest proportion, accounting for 26% of resistant bacteria, followed by methicillin-resistant Staphylococcus aureus (MRSA) accounted for 18%.1 with sepsis (Klebsiella pneumoniae). By Logistic regression analysis, the prognosis of patients with SCAP classification model:X1:heart failure;X2:the initial combined with antibiotics;X3:respiratory failure X4:age≥75years;X5:Septic shock.The results showed that age equal to or greater than 75 years, septic shock, heart failure and respiratory failure are risk factors for SCAP, The initial treatment combined with antibiotics is a protective factor. Odds ratio:septic shock> age equal to or greater than 75 years > respiratory failure>heart failure. When the age equal to or greater than 75 years, more complications, higher risk of death, the worse the prognosis. Strong classification ability and the fitting effect of the model,and the predictive value is good, it provides good guidance for ICU physicians to assess the prognosis of patients with SCAP and treatment plan, thus improving the survival rate in critically ill patients within the ICU.Conclusion:The group study showed that severe community acquired pneumonia is still a disease with critical condition,difficult to treat and high mortality, and the majority of patients are elderly, age equal to or greater than 75 years, septic shock, heart failure and respiratory failure are risk factors for SCAP, Sputum culture results suggest that SCAP patients infected with gram-negative bacteria dominated,and the resistant majority. The initial combination of antibiotics was a protective factor in patients with SCAP, therefore, early empirical anti-infective therapy should be combination broad-spectrum antibiotics which have strong ability of anti-Gram-negative bacilli with antibiotics that anti-Gram-positive cocci, pay attention to changes in pathogens and the monitoring of drug resistance In our hospital and the region,these have great significance on the antibiotic selection in the initial empirical treatment. In addition,be timely and correct treatment of SCAP with serious complications, adopt a comprehensive treatment based on anti-infection treatment, to improve the survival rate of patients with SCAP, rational use of medical resources and reduce hospitalization costs.