Analysis of clinical characteristics and death risk factors in patients with community-acquired pneumonia and sepsis_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

LI Peng ,  XIE Lihua ,  SUN Shenhua , LIU Chun

Department of Respiratory and Critical Diseases, Xiangya Third Hospital, Central South University, Changsha, Hunan 410000, P. R. China;

Corresponding?author：

XIE Lihua, Email: xyelyhua@163.com; SUN Shenhua, Email: sunsh311@hotmail.com

Keywords：

Community acquired pneumonia; sepsis; clinical features; risk factor analysis

DOI：

10.7507/1671-6205.202204009

Video：

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Objective To investigate the clinical characteristics and death risk factors of patients with community acquired pneumonia and sepsis. Methods Data of 350 patients with community-acquired pneumonia and sepsis admitted to the Intensive Care Unit of Third Xiangya Hospital of Central South University from January 2015 to October 2021 were retrospectively analyzed, and their basic characteristics, laboratory results and treatment were analyzed. Results The absolute value of white blood cell, neutrophil ratio, absolute value of neutrophil, inflammatory index, liver and kidney function, coagulation function, cardiac enzymology, lactic acid and sequential organ failure evaluation score of patients with community acquired pneumonia sepsis in the non-survival group were higher than those in the survival group. Logistic regression analysis showed that respiratory rate, heart rate, mean arterial pressure, blood oxygen saturation, C-reactive protein, D-dimer, lactic acid, creatinine and lymphocyte ratio may be independent risk factors for 28-day death in patients with community-acquired pneumonia and sepsis.The receiver operating characteristic curve shows that the combination of the above indicators to predict the risk of death of patients has the best sensitivity, specificity and maximum area under the curve, which is superior to the prediction value of individual variables. Conclusions Patients in the non-survivor group of community-acquired pneumonia sepsis had more severe inflammatory response and organ function impairment. Respiratory rate, heart rate, mean arterial pressure, blood oxygen saturation, C-reactive protein, D-dimer, lactic acid, creatinine, lymphocyte ratio and other indicators are independent risk factors for death of patients with community-acquired pneumonia and sepsis, which have better prognostic value when combined.

Citation： LI Peng, XIE Lihua, SUN Shenhua, LIU Chun. Analysis of clinical characteristics and death risk factors in patients with community-acquired pneumonia and sepsis. Chinese Journal of Respiratory and Critical Care Medicine, 2022, 21(4): 260-268. doi: 10.7507/1671-6205.202204009 Copy

1.	Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Intensive Care Med, 2021, 47(11): 1181-1247.
2.	Xie J, Wang H, Kang Y, et al. The epidemiology of sepsis in Chinese ICUs: a national cross-sectional survey. Crit Care Med, 2020, 48(3): e209-e218.
3.	Rudd KE, Johnson SC, Agesa KM, et al. Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study. Lancet, 2020, 395(10219): 200-211.
4.	張淋, 洪城, 孟新科, 等. 宏基因組學第二代測序技術對比傳統實驗室微生物培養在膿毒癥病原學診斷中的優勢. 中國急救醫學, 2022, 42(2): 114-120.
5.	Karampela I, Christodoulatos GS, Vallianou N, et al. Circulating chemerin and its kinetics may be a useful diagnostic and prognostic biomarker in critically ill patients with sepsis: a prospective study. Biomolecules, 2022, 12(2): 301.
6.	馮清, 吳龍, 艾宇航, 等. 重癥監護病房膿毒癥患者病原菌的流行病學特征. 中國感染控制雜志, 2018, 17(9): 777-782.
7.	Li X, Li T, Wang J, et al. Clinical value of C-reactive protein/platelet ratio in neonatal sepsis: a cross-sectional study. J Inflamm Res, 2021, 14: 5123-5129.
8.	Zhang W, Zhang Z, Pan S, et al. The clinical value of hematological neutrophil and monocyte parameters in the diagnosis and identification of sepsis. Ann Transl Med, 2021, 9(22): 1680.
9.	Metlay JP, Waterer GW, Long AC, et al. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med, 2019, 200(7): e45-e67.
10.	Yang Y, Dong J, Li Y, et al. Development and validation of a nomogram for predicting the prognosis in cancer patients with sepsis. Cancer Med, 2022, 11(12): 2345-2355.
11.	Hernandez-Quiles R, Merino-Lucas E, Boix V, et al. Bacteraemia and quick Sepsis Related Organ Failure Assessment (qSOFA) are independent risk factors for long-term mortality in very elderly patients with suspected infection: retrospective cohort study. BMC Infect Dis, 2022, 22(1): 248.
12.	Liang P, Yu F. Value of CRP, PCT, and NLR in prediction of severity and prognosis of patients with bloodstream infections and sepsis. Front Surg, 2022, 9: 857218.
13.	黃平, 杜治祥, 梁結玲, 等. 膿毒癥心血管功能損傷與臟器功能評估中膿毒癥相關標記物的應用價值探討. 齊齊哈爾醫學院學報, 2020, 41(14): 1730-1732.
14.	Wu Y, Yu C, Zhou Y, et al. Risk stratification and prognostic value of serum neutrophil gelatinase-associated lipocalin (sNGAL) in sepsis patients. Acta Biochim Pol, 2022, 69(1): 113-117.
15.	Liu S, Lim YH, Chen J, et al Long-term air pollution exposure and pneumonia-related mortality in a large pooled European cohort. Am J Respir Crit Care Med, 2022, 205(12): 1429-1439.
16.	陳麗, 熊劍飛. 重癥肺炎合并膿毒癥患者的臨床特征分析. 臨床急診雜志, 2021, 22(6): 369-372.
17.	劉環芹, 萬朝暉. 重癥膿毒癥休克患者預后影響因素的相關性分析. 河北醫藥, 2021, 43(22): 3427-3430.
18.	Tian T, Wei B, Wang J. Study of C-reactive protein, procalcitonin, and immunocyte ratios in 194 patients with sepsis. BMC Emerg Med, 2021, 21(1): 81.
19.	黃朋, 方戀, 陳波, 等. 重癥肺炎患者血清降鈣素原、C-反應蛋白、D 二聚體及炎癥因子水平變化及其臨床意義. 安徽醫藥, 2018, 22(3): 478-482.
20.	張怡, 宗媛, 武敏, 等. 膿毒癥患者血常規動態變化及預后相關性分析. 重慶醫學, 2018, 47(35): 4548-4550.
21.	李慧琳, 劉舒嫣, 劉盛, 等. 檢測膿毒癥患者白細胞分類及中性粒細胞/淋巴細胞比值的臨床意義. 熱帶醫學雜志, 2022, 22(1): 32-36.
22.	Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA, 2016, 315(8): 801.
23.	明穎, 李爽, 劉秋霞, 等. 血清炎癥因子、H-FABP 及 NT-proBNP 在老年膿毒癥患者早期診斷及預后評估中的應用. 中國老年學雜志, 2020, 40(22): 4815-4818.
24.	曹瑛, 欒正剛, 王亮, 等. 膿毒癥相關肝損傷臨床特點及預后分析. 中國實用內科雜志, 2019, 39(2): 163-167.
25.	Poston JT, Koyner JL. Sepsis associated acute kidney injury. BMJ, 2019, 364: k4891.
26.	Garg R, Tellapragada C, Shaw T, et al. Epidemiology of sepsis and risk factors for mortality in intensive care unit: a hospital based prospective study in South India. Infect Dis (Lond), 2022, 54(5): 325-334.
27.	Tang D, Wang H, Billiar T R, et al. Emerging mechanisms of immunocoagulation in sepsis and septic shock. Trends Immunol, 2021, 42(6): 508-522.
28.	Gando S, Shiraishi A, Yamakawa K, et al. Role of disseminated intravascular coagulation in severe sepsis. Thromb Res, 2019, 178: 182-188.
29.	尹小燕, 徐兵, 吳莘, 等. D-二聚體聯合血清白蛋白對急診科老年膿毒癥患者預后的評估. 中國臨床保健雜志, 2022, 25(1): 62-65.
30.	劉清, 彭麗媛. 入院 24 h 內 APACHEⅡ 評分及血乳酸值對 ICU 膿毒癥患者預后的預測價值. 現代臨床醫學, 2022, 48(1): 19-22.
31.	Vandewalle J, Timmermans S, Paakinaho V, et al. Combined glucocorticoid resistance and hyperlactatemia contributes to lethal shock in sepsis. Cell Metab, 2021, 33(9): 1763-1776.
32.	Yang K, Fan M, Wang X, et al. Lactate induces vascular permeability via disruption of VE-cadherin in endothelial cells during sepsis. Sci Adv, 2022, 8(17): m8965.
33.	張曉慧, 王玨, 陸燕飛, 等. 社區獲得性血流感染病原菌分布及預后危險因素分析. 南京醫科大學學報(自然科學版), 2022, 42(1): 117-120.
34.	侯盼飛, 張鑫, 祝麗晶, 等. 2019 年我院重癥監護病房病原菌分布及耐藥性監測. 中國實驗診斷學, 2021, 25(12): 1785-1789.
35.	文莎, 鄒志業, 何習斯, 等. 真菌培養陽性和陰性膿毒癥合并慢性阻塞性肺疾病患者的預后分析. 中國急救醫學, 2021, 41(10): 867-873.
36.	張錦鑫, 沈括, 胡大海, 等. 膿毒癥早期診斷和治療進展. 中華損傷與修復雜志(電子版), 2022, 17(1): 76-80.
37.	Dres M, Goligher EC, Heunks L, et al. Critical illness-associated diaphragm weakness. Intensive Care Med, 2017, 43(10): 1441-1452.
38.	衛夏迪, 劉虹, 李福東, 等. 膿毒癥 T 淋巴細胞的研究進展. 中華危重癥醫學雜志(電子版), 2021, 14(4): 327-330.
39.	趙立新, 王琳, 于四方, 等. 膿毒癥患者血清HMGB1水平與免疫指標、心肌損傷的相關性分析. 重慶醫學, 2021, 50(19): 3289-3293.
40.	林懷德, 周穩蘭, 朱蔚崗. 糖皮質激素治療對感染性休克患者免疫炎癥狀態及預后的影響. 臨床與病理雜志, 2021, 41(11): 2543-2549.
41.	孫玉景, 吳建華, 陳照家, 等. 基于膿毒癥患者免疫功能狀態個體化應用免疫調節劑的療效研究. 中國臨床研究, 2021, 34(9): 1199-1203.
42.	伍思賢, 賀道機, 葉永芝, 等. 免疫球蛋白治療兒童膿毒癥的臨床效果及對免疫功能的影響. 中國當代醫藥, 2021, 28(21): 112-114.

1. Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Intensive Care Med, 2021, 47(11): 1181-1247.
2. Xie J, Wang H, Kang Y, et al. The epidemiology of sepsis in Chinese ICUs: a national cross-sectional survey. Crit Care Med, 2020, 48(3): e209-e218.
3. Rudd KE, Johnson SC, Agesa KM, et al. Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study. Lancet, 2020, 395(10219): 200-211.
4. 張淋, 洪城, 孟新科, 等. 宏基因組學第二代測序技術對比傳統實驗室微生物培養在膿毒癥病原學診斷中的優勢. 中國急救醫學, 2022, 42(2): 114-120.
5. Karampela I, Christodoulatos GS, Vallianou N, et al. Circulating chemerin and its kinetics may be a useful diagnostic and prognostic biomarker in critically ill patients with sepsis: a prospective study. Biomolecules, 2022, 12(2): 301.
6. 馮清, 吳龍, 艾宇航, 等. 重癥監護病房膿毒癥患者病原菌的流行病學特征. 中國感染控制雜志, 2018, 17(9): 777-782.
7. Li X, Li T, Wang J, et al. Clinical value of C-reactive protein/platelet ratio in neonatal sepsis: a cross-sectional study. J Inflamm Res, 2021, 14: 5123-5129.
8. Zhang W, Zhang Z, Pan S, et al. The clinical value of hematological neutrophil and monocyte parameters in the diagnosis and identification of sepsis. Ann Transl Med, 2021, 9(22): 1680.
9. Metlay JP, Waterer GW, Long AC, et al. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med, 2019, 200(7): e45-e67.
10. Yang Y, Dong J, Li Y, et al. Development and validation of a nomogram for predicting the prognosis in cancer patients with sepsis. Cancer Med, 2022, 11(12): 2345-2355.
11. Hernandez-Quiles R, Merino-Lucas E, Boix V, et al. Bacteraemia and quick Sepsis Related Organ Failure Assessment (qSOFA) are independent risk factors for long-term mortality in very elderly patients with suspected infection: retrospective cohort study. BMC Infect Dis, 2022, 22(1): 248.
12. Liang P, Yu F. Value of CRP, PCT, and NLR in prediction of severity and prognosis of patients with bloodstream infections and sepsis. Front Surg, 2022, 9: 857218.
13. 黃平, 杜治祥, 梁結玲, 等. 膿毒癥心血管功能損傷與臟器功能評估中膿毒癥相關標記物的應用價值探討. 齊齊哈爾醫學院學報, 2020, 41(14): 1730-1732.
14. Wu Y, Yu C, Zhou Y, et al. Risk stratification and prognostic value of serum neutrophil gelatinase-associated lipocalin (sNGAL) in sepsis patients. Acta Biochim Pol, 2022, 69(1): 113-117.
15. Liu S, Lim YH, Chen J, et al Long-term air pollution exposure and pneumonia-related mortality in a large pooled European cohort. Am J Respir Crit Care Med, 2022, 205(12): 1429-1439.
16. 陳麗, 熊劍飛. 重癥肺炎合并膿毒癥患者的臨床特征分析. 臨床急診雜志, 2021, 22(6): 369-372.
17. 劉環芹, 萬朝暉. 重癥膿毒癥休克患者預后影響因素的相關性分析. 河北醫藥, 2021, 43(22): 3427-3430.
18. Tian T, Wei B, Wang J. Study of C-reactive protein, procalcitonin, and immunocyte ratios in 194 patients with sepsis. BMC Emerg Med, 2021, 21(1): 81.
19. 黃朋, 方戀, 陳波, 等. 重癥肺炎患者血清降鈣素原、C-反應蛋白、D 二聚體及炎癥因子水平變化及其臨床意義. 安徽醫藥, 2018, 22(3): 478-482.
20. 張怡, 宗媛, 武敏, 等. 膿毒癥患者血常規動態變化及預后相關性分析. 重慶醫學, 2018, 47(35): 4548-4550.
21. 李慧琳, 劉舒嫣, 劉盛, 等. 檢測膿毒癥患者白細胞分類及中性粒細胞/淋巴細胞比值的臨床意義. 熱帶醫學雜志, 2022, 22(1): 32-36.
22. Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA, 2016, 315(8): 801.
23. 明穎, 李爽, 劉秋霞, 等. 血清炎癥因子、H-FABP 及 NT-proBNP 在老年膿毒癥患者早期診斷及預后評估中的應用. 中國老年學雜志, 2020, 40(22): 4815-4818.
24. 曹瑛, 欒正剛, 王亮, 等. 膿毒癥相關肝損傷臨床特點及預后分析. 中國實用內科雜志, 2019, 39(2): 163-167.
25. Poston JT, Koyner JL. Sepsis associated acute kidney injury. BMJ, 2019, 364: k4891.
26. Garg R, Tellapragada C, Shaw T, et al. Epidemiology of sepsis and risk factors for mortality in intensive care unit: a hospital based prospective study in South India. Infect Dis (Lond), 2022, 54(5): 325-334.
27. Tang D, Wang H, Billiar T R, et al. Emerging mechanisms of immunocoagulation in sepsis and septic shock. Trends Immunol, 2021, 42(6): 508-522.
28. Gando S, Shiraishi A, Yamakawa K, et al. Role of disseminated intravascular coagulation in severe sepsis. Thromb Res, 2019, 178: 182-188.
29. 尹小燕, 徐兵, 吳莘, 等. D-二聚體聯合血清白蛋白對急診科老年膿毒癥患者預后的評估. 中國臨床保健雜志, 2022, 25(1): 62-65.
30. 劉清, 彭麗媛. 入院 24 h 內 APACHEⅡ 評分及血乳酸值對 ICU 膿毒癥患者預后的預測價值. 現代臨床醫學, 2022, 48(1): 19-22.
31. Vandewalle J, Timmermans S, Paakinaho V, et al. Combined glucocorticoid resistance and hyperlactatemia contributes to lethal shock in sepsis. Cell Metab, 2021, 33(9): 1763-1776.
32. Yang K, Fan M, Wang X, et al. Lactate induces vascular permeability via disruption of VE-cadherin in endothelial cells during sepsis. Sci Adv, 2022, 8(17): m8965.
33. 張曉慧, 王玨, 陸燕飛, 等. 社區獲得性血流感染病原菌分布及預后危險因素分析. 南京醫科大學學報(自然科學版), 2022, 42(1): 117-120.
34. 侯盼飛, 張鑫, 祝麗晶, 等. 2019 年我院重癥監護病房病原菌分布及耐藥性監測. 中國實驗診斷學, 2021, 25(12): 1785-1789.
35. 文莎, 鄒志業, 何習斯, 等. 真菌培養陽性和陰性膿毒癥合并慢性阻塞性肺疾病患者的預后分析. 中國急救醫學, 2021, 41(10): 867-873.
36. 張錦鑫, 沈括, 胡大海, 等. 膿毒癥早期診斷和治療進展. 中華損傷與修復雜志(電子版), 2022, 17(1): 76-80.
37. Dres M, Goligher EC, Heunks L, et al. Critical illness-associated diaphragm weakness. Intensive Care Med, 2017, 43(10): 1441-1452.
38. 衛夏迪, 劉虹, 李福東, 等. 膿毒癥 T 淋巴細胞的研究進展. 中華危重癥醫學雜志(電子版), 2021, 14(4): 327-330.
39. 趙立新, 王琳, 于四方, 等. 膿毒癥患者血清HMGB1水平與免疫指標、心肌損傷的相關性分析. 重慶醫學, 2021, 50(19): 3289-3293.
40. 林懷德, 周穩蘭, 朱蔚崗. 糖皮質激素治療對感染性休克患者免疫炎癥狀態及預后的影響. 臨床與病理雜志, 2021, 41(11): 2543-2549.
41. 孫玉景, 吳建華, 陳照家, 等. 基于膿毒癥患者免疫功能狀態個體化應用免疫調節劑的療效研究. 中國臨床研究, 2021, 34(9): 1199-1203.
42. 伍思賢, 賀道機, 葉永芝, 等. 免疫球蛋白治療兒童膿毒癥的臨床效果及對免疫功能的影響. 中國當代醫藥, 2021, 28(21): 112-114.

Chinese Journal of Respiratory and Critical Care Medicine

Analysis of clinical characteristics and death risk factors in patients with community-acquired pneumonia and sepsis

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