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

Abstract

ABSTRACTObjectivesSepsis 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.DesignA retrospective, single-centre study.SettingThis study was conducted at a tertiary hospital in Southern China.ParticipantsA 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.Interventionsnone.Outcome180-day mortality was the primary outcome.Results119 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).ConclusionDynamic 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.strengths and limitations of this studyWe evaluated dynamic monitoring of the duration of patients’ abnormal indicators can help predict the prognosis. To the best of our knowledge, a very few studies had done a dynamic monitoring of the duration of patients’ abnormal indicators in the field of SCAP with Sepsis. The retrospective nature of the study was a limitation, statistical data including respiratory support in later treatment, can be further quantified.