The mortality risk factor of severe community-acquired pneumonia (SCAP) patients with Sepsis: a retrospective study

Objectives: Sepsis is one of the most common comorbidities in severe
community-acquired pneumonia (SCAP) patients. We aimed to investigate the
characteristics and mortality risk factors of SCAP patients hospitalized
with Sepsis. Design: A retrospective, single-centre study. Setting: This
study was conducted at a tertiary hospital in Southern China.
Participants: A total of 119 patients with SCAP, aged 17 years or older,
were treated in the Integrated intensive care unit from 1 January 2018 to
30 December 2020. Interventions: none. Outcome: 180-day mortality was the
primary outcome. Results: 119 patients were divided into the survivors (83
patients,69.75%), and the non-survivors (36 patients,30.25%). There are
more pronounced inflammatory responses and respiratory problems at the
beginning of the disease in non-survivors, requiring stronger respiratory
and circulatory support. The CURB-65 score was a better predictor of
mortality than the PSI and APACHE2 scores, AUCs of CURB-65: OR 0.744,
p<0.005. For the entire treatment cycle, the non-survivors had a
longer duration of persistent fever, required continuous and repeated
airway intervention, and a longer duration of Vasopressor support
(P<0.001). SCAP with bacterial infection as the onset, or secondary
bacterial infection had a poor prognosis (P=0.018). The non-survivors had
more use of different types of antimicrobials (P<0.05), because of
Multidrug-resistant (MDR) organisms. And have faced more antifungal
treatment failures (P=0.006). The mortality risk factors were comorbid
with a duration of Vasopressors support, duration of persistent fever,
age, numbers of antimicrobials for MDR organisms, CURB-65 score and
duration of Neuromuscular Blocking Agents (NMBAs) (OR=1.234, OR=1.158,
OR=1.084, OR=6.484, OR=3.386, OR=1.505, p<0.005, respectively).
Conclusion: Dynamic monitoring of the duration of patients' abnormal
indicators can help predict the prognosis. Age≥65.5 years, fever duration
≥9.5 days, number of antimicrobials for MDR organisms ≥2 types, longer
NMBAs and Vasopressors use, and higher CURB-65 score were mortality risk
factors in SCAP-Sepsis patients.

研究目的：脓毒症是重症社区获得性肺炎（Severe Community-Acquired Pneumonia, SCAP）患者最常见的合并症之一。本研究旨在探讨合并脓毒症的SCAP住院患者的临床特征及死亡危险因素。
研究设计：回顾性单中心研究。
研究地点：本研究在中国南方某三级医院开展。
研究对象：2018年1月1日至2020年12月30日期间，于该院综合重症监护室接受治疗的119例年龄≥17岁的合并脓毒症的SCAP患者。
干预措施：无干预措施。
结局指标：主要结局指标为180天死亡率。
研究结果：119例患者被分为存活组（83例，占比69.75%）与非存活组（36例，占比30.25%）。非存活组患者在发病初期即呈现更为显著的炎症反应与呼吸系统功能障碍，需要更强力度的呼吸与循环支持。CURB-65评分对患者死亡率的预测效能优于PSI评分（肺严重程度指数）与APACHEⅡ评分，其曲线下面积（AUC）为0.744，P<0.005。在整个治疗周期内，非存活组患者的持续发热时长更长，需接受反复持续的气道干预，且血管升压药支持时长亦更长（P<0.001）。以细菌感染为起病诱因或继发细菌感染的SCAP患者预后较差（P=0.018）。由于多重耐药（Multidrug-resistant, MDR）菌感染，非存活组患者使用的抗菌药物种类更多（P<0.05），且抗真菌治疗失败的发生率更高（P=0.006）。最终筛选出的死亡危险因素包括：血管升压药支持时长、持续发热时长、年龄、针对多重耐药菌的抗菌药物使用种类、CURB-65评分以及神经肌肉阻滞药（Neuromuscular Blocking Agents, NMBAs）使用时长，对应的比值比（OR）分别为1.234、1.158、1.084、6.484、3.386、1.505，均P<0.005。
结论：动态监测患者异常指标的持续时长，有助于预测患者预后。年龄≥65.5岁、发热时长≥9.5天、针对多重耐药菌的抗菌药物使用种类≥2种、神经肌肉阻滞药与血管升压药使用时长更长，以及CURB-65评分更高，均为SCAP合并脓毒症患者的死亡危险因素。