| Objective:To explore the risk factors of,severe community-acquired pneumonia(SCAP)and construct an effective risk prediction model by observing the characteristics of clinical indicators of elderly patients with communi ty-acquired pneumonia(CAP).Methods:A retrospective study was conducted to collect the data of 309 elderly CAP patients,who hospi talized in the Second Affiliated Hospital of Guangzhou University of Tradit ional Chinese Medicine from January 2013 to December 2017.They were divided into case group(with severe pneumonia transformation group)and control group(wi thout severe pneumonia transformation group).The general,the clini cal features,laboratory examination,etiological types,CURB-65 score and TCM syndrome differentiation of the two groups were collected.Data were used to identify possibler isk factors as the indicators,quantizing the indicators and constr uct ing the risk predict model by using Logistic regression.Results:1.Baseline data:A total of 309 elderly CAP patients were includod in the study,including 123 in the case group and 186 in the contrll group.There were 122 males and 64 females in the control group,with an average ago of 88.21±3.52 years old,76.9%of the population were distributed in 75-89 years old,and 22.6%of the population were distributed in ?90 years old.There were 77 males and 46 females in the case gtroup,with an average ago of 80.14±8.27 years old,70.7%of the population were distributed in 75-89 years old,and 22.8%of the population were distributed in 60-74 yesrs old.In addition to age,age distrihution,duration of illness,total hospitalization costs,There was no statistieally significant different in the gender,BMI,age distribution,long-term bedridden history,smoking history,alcohol history,long-terrn residential care homes/care facilities,aspiration/dysphagia,history of antibiotic use before admission and whether was admitted to the ICU 3 months before admission(P>0.05).2.Combined diseases:Both groups of patients are mairily associated with cardiovascular disease,respiratory diseases,and cerebrovascular diseases.3.Clinical symptoms:The top three main symptoms in the control group were sputum,cough,and loss of appetite,while those in the case group were poor appetite,sputum,and difficulty in spit.4.Tongue and moss:The top 3 tongues color in the control group were dark red tongue,red tongue and light tongue,while the case group was pale tongue,dark red tongue and red tongue.The tongue coat ing of the two groups were mainly yellow and white fur.5.Pulse:The top three in the control group were respectively the slippery pulse,the string pulse,and the pulse,and the case group wais the slippery pulse,the fine vein,and the string pulse.6.Pulse patterns:The top three pulse patterns in the control group were slippery pulse,string pulse and several pulse respectively,while those in the case group were slippery pulse,vesicle pulse and string pulse.7.Pneumonia site and CURB-65 score:17.5%of left pneumonia,16.9%of right pneumonia,and 65.6%of bilateral pneumonia in the control group;CURB-65 score 0-1 accounted for 45.3%,2-score 42.0%,3-5 score 12.7%.In the case group,5.3%of left pneumonia,5.9%of right pneumonia,78.8%of bilateral pneumonia,and the CURB-65 score 0-1 accourlted for 24.6%,2-score 42.4%,3-5 score 33.1%.8.Etiology:There was no signifieant difference in the detection rate of pathogenic micoorganims before conversion to severe pneumonia in the two groups(P>0.05),but there was sigilificant difference in the detection of mycoplasma pneumoniae between the two groups(P<0.05).There were 17 cases in the control group and 5 cases in the case group.9.Syndrome classification:The main syndrorne differentiation of the control group was phlegm-heat-sickness syndrome,the mail disease,positiorn elements were lung,spleen and kidney;the syndrome differeltiation of the case group was qi deficiency,phlegm and heat stasis syndrome,and the main disease position elements were lung and spleen,kidney and meridian.The two groups of pathological factors are fire(heat),phlegm,qi deficiency,blood stasis.10.Univariate analysis:Age,acute coronary syndrome,history of congestive heart failure,cardiac insufficiency,respiratory failure,urinary tract disease,respiratory disease,syndrome,procalcitonin,D-dimer,Type B natriuretic peptide,percenta.ge of neutrophils,percentage of lymphocytes,platelets,blood potassium,blood chlorine,blood sodium,urea,albumin,pH,carbon dioxide partial pressure,aspartate aminotransferase,hypersensitive troponin T,creatine The kinase isoenzyme,pneumonia site,Mycoplasma pneumoniae,and CURB-65 scores were assoeiated with the occurrence of severe pneumonia in the elderly(P<0.05).11.Multivariate analysis:age is a protective factor for severe pneumonia in elderly patients,respiratory failure(OR=5.901,95%CI=2.3-15.953),D-dimer(OR=4.514,95%CI=0.919-29.130),albumin(OR=4.285,95%CI=1.274-16.468),blood,soclium,aspartate aminotransferase,creatine kinase isoenzyme,and,syndrome are risk factors for severe pneumonia in the elderly.2 In this study,the risk of developing severe pneumonia from high to low was:Qi and Yin deficiency,phlegm and heat stasis syndrome(OR=16.069,95%CI=0.924-440.645),Qi doficiency and phlegm obstruct ion syndrone(OR=4.249,95%CI=0.274-101.516),Qi deficiency,phlogm and heat stasis syndrome(OR=2.357,95%CI=0.212-41.921),lung spleen and kidney deficiency,phlegm heat and phlegm syndrome(OR=1.035,95%CI=0.076-20.255),wind-heated lung syndrome,lung spleen and kidney defieiency,phlegm obstruction and lung syndrome(OR=0.9537,95%CI=0.069-17.440),phlegm-heating lung syndrome(OR=0.799,95%CI=0.065-14.814),Qi and Yin deficiency,heat and phlegm syndrome(OR=0.431,95%CI=0.015-13.684).12.Logistic regressiorn equation:logi t P=0.9322-4.0793X1-1-5.8530X1-2+1.7751X2+1.5071X3-0.8900X1-1+1.5916X1-2+1.4550X5-1.3633X6-1+0.9019X6-2+1.3105X7-0.2241X8-1+0.0346X8-2-0.0790Xs-3+0.8572 X8-4+1.4468X8-5-0.8418 X8-6+2.7769 X8-7+0.4938 X8-8 age(75-89 years old,VS60-74 years)=X1-1;age(?90 years old,VS60-74 years old)=X1-2;respiratory failure-X2;d-dimer increased=X3;low sodium=X4-1;high,sodium=X4-2;albumin(<40g/L)=X5;glutamic oxaloacetic transaminase decreased = X6-1;glutamic oxaloacetic transaminase increased=X6-2;creatine kinase isoenzyme increased=X7;syndrome type(phlegm-heat obstructing the lung,syndrome VS wind-heat invading lung,syndrome)=X8-1;syndrome type(deficiency of lung,spleen and kidney,Phlegm-heat obstructing lung syndrome VS wind-heat invading lung syndrome)=X8-2;syndrome type.(deficiency of lung and spleen and kidney,phlegm-turbid obstructing lung syndrome VS wind-heat invading lung syndrome)=X8-3,;syndrome type(qi deficiency,phlegm-heat and blood stasis syndrome VS wind-heat invading lung syndrome)=X8-4;Syndrome type(qi deficiency,phlegm and blood stasis syndrome VS wind-heat invading lung syndrome)=X8-5;syndrome type(deficiency of both qi and yin,phlegm-heat obstructing lung syndrome VS wind-heat invading lung syndrome)=X8-6;syndrome type(deficiency of both qi and yin,phlegm-heat and blood stasis syndrome VS wind-heat invading lung syndrome)=X8-7;syndrome type(others syndrome types VS wind-heat invaciing lung syndrome)=X8-8Regression model evaluation:Hosmer&Lemeshow goodness of fit test Chi-Square=10.9896,DF=8,P=0.2023).Conclusion:The results showed that age was the protective factor for the severity of pneumonia in the elderly,and respiratory failure,D-dimer,albumin,serum sodium,glutamic oxaloacetic transaminase,creatine kinase isoenzyme and syndrome type were the risk factors for the severity of pneumonia in the elderly.2.The risk of each syndrome type developing into severe pneumonia from high to low were syndrome of deficiency of both qi and yin,phlegm,heat and blood stasis,syndrome of qi deficiency,phlegm and blood stasis blocking collaterals,syndrome of qi deficiency,phlegm,heat and blood stasis,syndrome of deficiency of lung,sp]een and kidney,phlegm-heat obstructing lung,syndrome of wind-heat invading lung,syndrome of deficiency of lung,spleen and kidney,obstruction of lung by phlegm and turbid phlegm,syndrome of phlegn-heat obstructing the lung.The regres,sion model has good discrimination and fitting degree,and the standard established by this model can provide a reference basis for the prediction ofsevere pneumonia in the elderly. |
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