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.	张淋, 洪城, 孟新科, 等. 宏基因组学第二代测序技术对比传统实验室微生物培养在脓毒症病原学诊断中的优势. 中国急救医学, 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.	冯清, 吴龙, 艾宇航, 等. 重症监护病房脓毒症患者病原菌的流行病学特征. 中国感染控制杂志, 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.	黄平, 杜治祥, 梁结玲, 等. 脓毒症心血管功能损伤与脏器功能评估中脓毒症相关标记物的应用价值探讨. 齐齐哈尔医学院学报, 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.	陈丽, 熊剑飞. 重症肺炎合并脓毒症患者的临床特征分析. 临床急诊杂志, 2021, 22(6): 369-372.
17.	刘环芹, 万朝晖. 重症脓毒症休克患者预后影响因素的相关性分析. 河北医药, 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.	黄朋, 方恋, 陈波, 等. 重症肺炎患者血清降钙素原、C-反应蛋白、D 二聚体及炎症因子水平变化及其临床意义. 安徽医药, 2018, 22(3): 478-482.
20.	张怡, 宗媛, 武敏, 等. 脓毒症患者血常规动态变化及预后相关性分析. 重庆医学, 2018, 47(35): 4548-4550.
21.	李慧琳, 刘舒嫣, 刘盛, 等. 检测脓毒症患者白细胞分类及中性粒细胞/淋巴细胞比值的临床意义. 热带医学杂志, 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.	明颖, 李爽, 刘秋霞, 等. 血清炎症因子、H-FABP 及 NT-proBNP 在老年脓毒症患者早期诊断及预后评估中的应用. 中国老年学杂志, 2020, 40(22): 4815-4818.
24.	曹瑛, 栾正刚, 王亮, 等. 脓毒症相关肝损伤临床特点及预后分析. 中国实用内科杂志, 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, 吴莘, 等. D-二聚体联合血清白蛋白对急诊科老年脓毒症患者预后的评估. 中国临床保健杂志, 2022, 25(1): 62-65.
30.	刘清, 彭丽媛. 入院 24 h 内 APACHEⅡ 评分及血乳酸值对 ICU 脓毒症患者预后的预测价值. 现代临床医学, 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.	张晓慧, 王珏, 陆燕飞, 等. 社区获得性血流感染病原菌分布及预后危险因素分析. 南京医科大学学报(自然科学版), 2022, 42(1): 117-120.
34.	侯盼飞, 张鑫, 祝丽晶, 等. 2019 年我院重症监护病房病原菌分布及耐药性监测. 中国实验诊断学, 2021, 25(12): 1785-1789.
35.	文莎, 邹志业, 何习斯, 等. 真菌培养阳性和阴性脓毒症合并慢性阻塞性肺疾病患者的预后分析. 中国急救医学, 2021, 41(10): 867-873.
36.	张锦鑫, 沈括, 胡大海, 等. 脓毒症早期诊断和治疗进展. 中华损伤与修复杂志(电子版), 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.	卫夏迪, 刘虹, 李福东, 等. 脓毒症 T 淋巴细胞的研究进展. 中华危重症医学杂志(电子版), 2021, 14(4): 327-330.
39.	赵立新, 王琳, 于四方, 等. 脓毒症患者血清HMGB1水平与免疫指标、心肌损伤的相关性分析. 重庆医学, 2021, 50(19): 3289-3293.
40.	林怀德, 周稳兰, 朱蔚岗. 糖皮质激素治疗对感染性休克患者免疫炎症状态及预后的影响. 临床与病理杂志, 2021, 41(11): 2543-2549.
41.	孙玉景, 吴建华, 陈照家, 等. 基于脓毒症患者免疫功能状态个体化应用免疫调节剂的疗效研究. 中国临床研究, 2021, 34(9): 1199-1203.
42.	伍思贤, 贺道机, 叶永芝, 等. 免疫球蛋白治疗儿童脓毒症的临床效果及对免疫功能的影响. 中国当代医药, 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. 张淋, 洪城, 孟新科, 等. 宏基因组学第二代测序技术对比传统实验室微生物培养在脓毒症病原学诊断中的优势. 中国急救医学, 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. 冯清, 吴龙, 艾宇航, 等. 重症监护病房脓毒症患者病原菌的流行病学特征. 中国感染控制杂志, 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. 黄平, 杜治祥, 梁结玲, 等. 脓毒症心血管功能损伤与脏器功能评估中脓毒症相关标记物的应用价值探讨. 齐齐哈尔医学院学报, 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. 陈丽, 熊剑飞. 重症肺炎合并脓毒症患者的临床特征分析. 临床急诊杂志, 2021, 22(6): 369-372.
17. 刘环芹, 万朝晖. 重症脓毒症休克患者预后影响因素的相关性分析. 河北医药, 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. 黄朋, 方恋, 陈波, 等. 重症肺炎患者血清降钙素原、C-反应蛋白、D 二聚体及炎症因子水平变化及其临床意义. 安徽医药, 2018, 22(3): 478-482.
20. 张怡, 宗媛, 武敏, 等. 脓毒症患者血常规动态变化及预后相关性分析. 重庆医学, 2018, 47(35): 4548-4550.
21. 李慧琳, 刘舒嫣, 刘盛, 等. 检测脓毒症患者白细胞分类及中性粒细胞/淋巴细胞比值的临床意义. 热带医学杂志, 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. 明颖, 李爽, 刘秋霞, 等. 血清炎症因子、H-FABP 及 NT-proBNP 在老年脓毒症患者早期诊断及预后评估中的应用. 中国老年学杂志, 2020, 40(22): 4815-4818.
24. 曹瑛, 栾正刚, 王亮, 等. 脓毒症相关肝损伤临床特点及预后分析. 中国实用内科杂志, 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, 吴莘, 等. D-二聚体联合血清白蛋白对急诊科老年脓毒症患者预后的评估. 中国临床保健杂志, 2022, 25(1): 62-65.
30. 刘清, 彭丽媛. 入院 24 h 内 APACHEⅡ 评分及血乳酸值对 ICU 脓毒症患者预后的预测价值. 现代临床医学, 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. 张晓慧, 王珏, 陆燕飞, 等. 社区获得性血流感染病原菌分布及预后危险因素分析. 南京医科大学学报(自然科学版), 2022, 42(1): 117-120.
34. 侯盼飞, 张鑫, 祝丽晶, 等. 2019 年我院重症监护病房病原菌分布及耐药性监测. 中国实验诊断学, 2021, 25(12): 1785-1789.
35. 文莎, 邹志业, 何习斯, 等. 真菌培养阳性和阴性脓毒症合并慢性阻塞性肺疾病患者的预后分析. 中国急救医学, 2021, 41(10): 867-873.
36. 张锦鑫, 沈括, 胡大海, 等. 脓毒症早期诊断和治疗进展. 中华损伤与修复杂志(电子版), 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. 卫夏迪, 刘虹, 李福东, 等. 脓毒症 T 淋巴细胞的研究进展. 中华危重症医学杂志(电子版), 2021, 14(4): 327-330.
39. 赵立新, 王琳, 于四方, 等. 脓毒症患者血清HMGB1水平与免疫指标、心肌损伤的相关性分析. 重庆医学, 2021, 50(19): 3289-3293.
40. 林怀德, 周稳兰, 朱蔚岗. 糖皮质激素治疗对感染性休克患者免疫炎症状态及预后的影响. 临床与病理杂志, 2021, 41(11): 2543-2549.
41. 孙玉景, 吴建华, 陈照家, 等. 基于脓毒症患者免疫功能状态个体化应用免疫调节剂的疗效研究. 中国临床研究, 2021, 34(9): 1199-1203.
42. 伍思贤, 贺道机, 叶永芝, 等. 免疫球蛋白治疗儿童脓毒症的临床效果及对免疫功能的影响. 中国当代医药, 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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