慢性阻塞性肺疾病急性加重合并铜绿假单胞菌感染的危险因素、临床特征及短期预后分析

Clinical features,short-term prognosis and risk factors of Pseudomonas aeruginosa infection in patients with acute exacerbation of chronic obstructive pulmonary disease

目的探讨慢性阻塞性肺疾病(简称慢阻肺)急性加重住院患者合并铜绿假单胞菌感染的临床特点、危险因素及短期预后。方法收集2017年9月—2021年7月国内10家三甲医院因慢阻肺急性加重住院的患者,以慢阻肺急性加重合并铜绿假单胞菌感染患者作为病例组,在慢阻肺急性加重不合并铜绿假单胞菌感染的病例中,按照2∶1的比例随机选取与病例组同时期同中心住院的患者作为对照组,进行病例对照研究。比较两组患者入院时基础情况、合并症、临床表现及预后等指标的差异,并探讨慢阻肺急性加重合并铜绿假单胞菌感染的危险因素。结果总共纳入14007例慢阻肺急性加重住院患者,其中慢阻肺急性加重合并铜绿假单胞菌感染患者338例,发病率为2.41%。慢阻肺急性加重合并铜绿假单胞菌感染组的预后较对照组更差,具体表现在院内死亡率更高(4.4%比1.9%,P=0.02)、住院时间更长[13.0(9.0,19.25)d比(8.0,15.0)d,P=0.002]。在临床特点方面,慢阻肺急性加重合并铜绿假单胞菌感染的患者出现咳嗽、咯痰、咯脓痰、呼吸困难的比例较对照组更高,炎症指标(中性粒细胞百分比、红细胞沉降率等)、动脉血气中二氧化碳分压高于对照组,而血清白蛋白水平低于对照组(均P<0.05)。多因素Logistic回归分析显示,帕金森病[比值比(odds ratio,OR)=5.14,95%可信区间(confidence interval,CI)1.43~18.49,P=0.012]、支气管扩张(OR=4.97,95%CI 3.70~6.67,P<0.001)、有创机械通气(OR=2.03,95%CI 1.23~3.36,P=0.006)、血清白蛋白<35 g/L(OR=1.40,95%CI 1.04~1.88,P=0.026)、二氧化碳分压≥45 mm Hg(OR=1.38,95%CI 1.01~1.90,P=0.046)是慢阻肺急性加重合并铜绿假单胞菌感染的危险因素。结论慢阻肺急性加重住院患者合并铜绿假单胞菌感染发病率高,预后较差。帕金森病、支气管扩张、有创机械通气、血清白蛋白<35 g/L、二氧化碳分压≥45 mm Hg是慢阻肺急性加重住院患者合并铜绿假单胞菌感染的危险因素。

Objective To study the clinical features,short-term prognosis and risk factors of Pseudomonas Aeruginosa(P.aeruginosa)infection in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods This study enrolled patients hospitalized for AECOPD in ten tertiary hospitals of China from September 2017 to July 2021.AECOPD patients with P.aeruginosa infection were included as case group,AECOPD patients without P.aeruginosa infection were randomly selected as control group from the same hospitals and same hospitalization period as the patients in case group,at a ratio of 2∶1.The differences in basic conditions,complications,clinical manifestations on admission and in-hospital prognosis between the two groups were compared,and the risk factors of P.aeruginosa infection were analyzed.Results A total of 14007 inpatients with AECOPD were included in this study,and 338 patients were confirmed to have P.aeruginosa infection during hospitalization,with an incidence rate of 2.41%.The in-hospital prognosis of AECOPD patients with P.aeruginosa infection was worse than that of the control group,which was manifested in higher hospital mortality(4.4%vs.1.9%,P=0.02)and longer hospital stay[13.0(9.0,19.25)d vs.11.0(8.0,15.0)d,P=0.002].In terms of clinical features,the proportions of patients with cough,expectoration,purulent sputum,dyspnea in the case group were higher than those in the control group,and the inflammatory indicators(neutrophil ratio,erythrocyte sedimentation rate)and partial pressure of carbon dioxide in arterial blood gas were higher than those in the control group,while the serum albumin was significantly lower than that in the control group(all P<0.05).Multivariate logistic regression analysis showed that Parkinson's disease[odds ratio(OR)=5.14,95%confidence interval(CI):1.43 to 18.49,P=0.012],bronchiectasis(OR=4.97,95%CI:3.70 to 6.67,P<0.001),invasive mechanical ventilation(OR=2.03,95%CI:1.23 to 3.36,P=0.006),serum albumin<35 g/L(OR=1.40,95%CI:1.04 to 1.88,P=0.026),partial pressure of carbon dioxide≥45 mm Hg(OR=1.38,95%CI:1.01 to 1.90,P=0.046)were independent risk factors for P.aeruginosa infection in AECOPD patients.Conclusions P.aeruginosa infection has a relative high morbidity and poor outcome among AECOPD inpatients.Parkinson’s disease,bronchiectasis,invasive mechanical ventilation,serum albumin below 35 g/L,partial pressure of carbon dioxide≥45 mm Hg are independent risk factors of P.aeruginosa infection in AECOPD inpatients.