Ullah Arslan Rahat, Masood Aysha, Amin Sumayya, Ali Iftikhar
Dr. Arslan Rahat Ullah, FCPS. Department of Medicine & Allied, Northwest General Hospital & Research Centre, Peshawar, Pakistan.
Dr. Aysha Masood, MBBS. Department of Thoracic medicine, Royal Bournemouth Hospital, Castle Ln E, Bournemouth BH7 7DW, United Kingdom.
Pak J Med Sci. 2022 Mar-Apr;38(4Part-II):1031-1037. doi: 10.12669/pjms.38.4.5312.
To explore the risk factors, pathogens and outcomes of severe community-acquired pneumonia (SCAP) in patients with respiratory failure.
A prospective observational study was conducted at Northwest General Hospital & Research Centre, Peshawar, Pakistan from February 2016 to October 2018. All patients with Community-acquired pneumonia (CAP) who fulfilled the inclusion criteria were recorded consecutively. Diagnosis of SCAP was made following the criteria established by the IDSA/ATS in the consensus guidelines on the management of CAP in adults published in 2007. In-hospital mortality was the main outcome.
The final analysis comprised a total of 100 patients with SCAP. The mean age was 60.0±18.01 years, and 54.0% were female patients. Afghani patients represented 22.0% of the total patients. The most common comorbidity associated with SCAP was hypertension (42.0%). The most commonly isolated etiological agents were Acinetobacter baumannii, followed by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli. In-hospital mortality was 45%. On multivariate analysis, factors associated with in-hospital mortality were age (OR 1.054; 95%Cl 1.01-1.10; p=0.021), presence of two or more complications (OR 4.51; 95%Cl 1.18-17.28; p=0.028), septic shock (OR 6.44; 95%Cl 1.55-26.803; p=0.010), length of mechanical ventilation (OR 1.17; 95%Cl 1.01-1.40; p=0.043), and paO (OR 4.51; 95%Cl 1.18-17.28; p=0.004).
A high mortality rate was observed in our study. Age, presence of two or more complications, septic shock, length of mechanical ventilation, and low paO were identified to be independent predictors of mortality for patients with SCAP.
探讨呼吸衰竭患者中重症社区获得性肺炎（SCAP）的危险因素、病原体及转归。
2016年2月至2018年10月在巴基斯坦白沙瓦西北综合医院及研究中心进行了一项前瞻性观察性研究。连续记录所有符合纳入标准的社区获得性肺炎（CAP）患者。按照2007年发布的成人CAP管理共识指南中美国感染病学会（IDSA）/美国胸科学会（ATS）制定的标准诊断SCAP。院内死亡率是主要结局。
最终分析共纳入100例SCAP患者。平均年龄为60.0±18.01岁，女性患者占54.0%。阿富汗患者占总患者数的22.0%。与SCAP相关最常见的合并症是高血压（42.0%）。最常分离出的病原体是鲍曼不动杆菌，其次是产超广谱β-内酰胺酶（ESBL）的大肠埃希菌。院内死亡率为45%。多因素分析显示，与院内死亡率相关的因素有年龄（OR 1.054；95%CI 1.01 - 1.10；p = 0.021）、存在两种或更多并发症（OR 4.51；95%CI 1.18 - 17.28；p = 0.028）、感染性休克（OR 6.44；95%CI 1.55 - 26.803；p = 0.010）、机械通气时间（OR 1.17；95%CI 1.01 - 1.40；p = 0.043）及动脉血氧分压（OR 4.51；95%CI 1.18 - 17.28；p = 0.004）。
我们的研究中观察到较高的死亡率。年龄、存在两种或更多并发症、感染性休克、机械通气时间及低动脉血氧分压被确定为SCAP患者死亡率的独立预测因素。
