The Epidemiological Characteristics And Analysis Of Risk Factors For Prognosis Of Patients With Community-acquired Pneumonia

Objective : The study aimed to investigate the epidemiological characteristics and the independent prognostic risk factors for mortality in the patients with community-acquired pneumonia(CAP),to provide a better reference for prevention and treatment of CAP.Methods:713 hospitalised patients with CAP in the Affiliated Hospital of Southwest Medical University were studied from January 2015 to December 2016.Basic information,vital signs,chief complains,comorbidities were recorded.Laboratory tests,chest X-rays or computed tomography(CT)were performed upon admission.All patients were divided into the elderly group(≥65)and the non-elderly group(< 65)according to age,and the death group and the survival group according to clinical outcome.The general conditions,clinical features,causative organisms distribution were compared between the elderly group and the non-elderly group.Several independent prognostic risk factors for mortality were identified.Results:(1)Compared with the non-elderly,comorbidities,such as chronic obstructive pulmonary disease(COPD),hypertension,coronary heart disease,renal insufficiency,cerebrovascular disease were more common inthe elderly(P < 0.05).(2)The elderly CAP,often lacking the typical symptoms such as fever,cough,purulent sputum and chest pain observed in the non-elderly(P<0.05),present with dyspnea,nausea and vomiting(P<0.05).(3)When compared with the non-elderly,leukocyte count,the concentration of sensitive troponin I and d-dimer were higher in the elderly(P<0.05),and hypoalbuminemia,multi lobe infiltration were more common in the elderly(P<0.05).(4)Etiology:with an overall positive rate of 40.60%,Staphylococcus,Pseudomonas aeruginosa,Escherichia coli and Hemolytic acinetobcuter bauman were more common isolated in the elderly group.(P<0.05).(5)Gram-negative bacilli dominate the pathogen of CAP.The main isolated bacilli,including Klebsiella,Escherichia coli and Pseudomonas aeruginosa,maintain a high susceptibility of 90% to carbopenems,amilacin and cepalosporins.Klebsiella and Escherichia coli maintain a susceptibility of above 50 % to Piperacillin,Cafazolin,Cefuroxime and Cafepime,and Pseudomonas aeruginosa maintain a resistance rate of above 50 % to Levofloxacin.(6)Univariate logistic regression anslyses revealed age,COPD,diabetes mellitus,cerebrovascular disease,renal insufficiency,hypoalbuminemia,mechanical ventilation,CURB-65≥2,hyponatremia,hypokalemia,bedridden,dysphagia were the risk factors affecting the prognosis(P < 0.05).(7)Multivariate analysis showed diabetes mellitus,renal insufficiency,hypoalbuminemia,mechanical ventilation,hyponatremia were the independent risk factors(P<0.05).Conclusions:(1)CAP were more common in the elderly in this research,presenting with less respiratory syndromes and more atypical clinical manifestation.(2)In this research,the predominantly pathogenic bacteria of CAP were Gram-negative bacilli which maintain a high sensitivity to carbapenems,amilacin and beta-lactamase inhibitor antibiotics.(3)Diabetes mellitus,renal insufficiency,hypoalbuminemia,mechanical ventilation,hyponatremia were the independent prognostic risk factors for CAP in this research.