社区获得性重症肺炎患者死亡风险因素探讨

Study on Risk Factors of Death in Patients with Community-acquired Severe Pneumonia

目的探讨社区获得性重症肺炎死亡相关危险因素,为进一步优化社区获得性重症肺炎治疗提供理论依据。方法回顾性收集2020年1月-2022年12月川北医学院附属医院住院的社区获得性重症肺炎患者资料,并将纳入的病例分为存活组与死亡组。通过多因素Logistic回归分析死亡相关危险因素,联合实验室检查指标绘制受试者工作特征曲线(ROC曲线)分析各指标对社区获得性重症肺炎的预测价值。结果共收集了230例社区获得性重症肺炎病例,其中死亡组78例(33.91%),存活组152例(66.09%)。两组年龄、性别、是否合并高血压、是否合并慢性阻塞性肺疾病比较,差异无统计学意义(P>0.05);两组实验室指标中C反应蛋白(CRP)、降钙素原(PCT)、白介素6(IL-6)、N末端B型脑钠肽前体(NT-proBNP)、丙氨酸氨基转移酶(ALT)、肌钙蛋白T(cTnT)、凝血酶原时间(PT)、乳酸(LAC)、D-二聚体(D-Dimer)和铁蛋白(Ferritin)比较,差异有统计学意义(P<0.05);LAC、IL-6、铁蛋白联合预测死亡风险的截断值0.174,约登指数0.858,灵敏度92.20%,特异度93.60%,其ROC曲线下面积(AUC)为0.968[95%CI(0.94,0.996)]。结论LAC、IL-6、铁蛋白增高均是社区获得性重症肺炎死亡独立危险因素,四者联合对社区获得性重症肺炎死亡具有更高的预测价值。

Objective To explore the risk factors of death in community-acquired severe pneumonia,and to provide a theoretical basis for further optimizing the treatment of community-acquired severe pneumonia.Methods The data of patients with community-acquired severe pneumonia during hospitalization in the Affiliated Hospital of North Sichuan Medical College from January 2020 to December 2022 were retrospectively collected,and the included cases were divided into survival group and death group.Multivariate Logistic regression analysis was used to analyze the risk factors related to death,and the receiver operating characteristic curve(ROC curve)was drawn to analyze the predictive value of each index for community-acquired severe pneumonia.Results A total of 230 patients with community-acquired severe pneumonia were collected,including 78 patients(33.91%)in the death group and 152 patients(66.09%)in the survival group.There was no significant difference in age,gender,hypertension and chronic obstructive pulmonary disease between the two groups(P>0.05).There were significant differences in C-reactive protein(CRP),troponin T(cTnT),procalcitonin(PCT),interleukin-6(IL-6),N-terminal pro-brain natriuretic peptide(NT-proBNP),alanine aminotransferase(ALT),prothrombin time(PT),lactic acid(LAC),D-dimer(D-Dimer)and ferritin(Ferritin)between the two groups(P<0.05).The cut-off value of LAC,IL-6 and Ferritin combined to predict the risk of death was 0.174,the Youden index was 0.858,the sensitivity was 92.20%,the specificity was 93.60%,and the area under the ROC curve(AUC)was 0.968[95%CI(0.94,0.996)].Conclusion The increase of LAC,IL-6 and Ferritin is an independent risk factor for the death of community-acquired severe pneumonia.The combination of the four has a higher predictive value for the death of community-acquired severe pneumonia.