Zhang Jingyuan, Hu Xinyu, Aili Ailifeila, Pan Lei, Xue Xinying, Chen Xiaolan
Department of Respiratory and Critical Care Medicine, Emergency and Critical Care Medical Center, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China.
Diagnostics (Basel). 2025 Jun 26;15(13):1627. doi: 10.3390/diagnostics15131627.
: Refractory community-acquired pneumonia (r-CAP) has become a thorny issue in clinical practice, especially after the COVID-19 pandemic, even in immunocompetent patients, as conventionally defined. In this study, we aimed to identify the risk factors for immunocompetent patients with r-CAP. This was a single-center retrospective study. In total, we collected clinical data from 82 patients with r-CAP in whom the first-line antibiotic therapy failed and 82 patients with general CAP (g-CAP) who recovered with first-line antibiotics, matched at a ratio of 1:1, admitted to Beijing Shijitan Hospital, Capital Medical University, from 1 January 2022, to 31 December 2023. The differences between the two groups (clinical characteristics, peripheral blood cell count, lymphocyte subsets, and regular laboratory indicators) were analyzed using paired , paired Wilcoxon, Chi-square, or Fisher's exact tests, and univariate and multivariate logistics regression analyses were conducted to identify the independent risk factors. A model for predicting indicators with statistical significance was established and proved with the receiver operating characteristic (ROC) curve. : Warm season, a history of chronic obstructive pulmonary disease, longer time from onset to admission (T), higher percentages of CD4 T, CD8 T, and double-negative T (DNT) lymphocytes, as well as higher levels of C-reactive protein (CRP), low-density lipoprotein cholesterin (LDL-C), serum sodium ion (Na), and free-calcium ion (FCa) were regarded as independent risk factors, while T lymphocyte percentage (T%) and total cholesterol (TC) were identified as protective factors. The combined multivariate model using all the above factors proved to be sensitive and specific (AUC = 0.8711, < 0.0001, R = 0.4235), and thus better than the respective univariate models. : Increased CD4 T%Lym, CD8 T%Lym, and DNT%Lym, warm season, a history of COPD, longer T, and increased levers of CRP, LDL-C, Na, and FCa potentially cause CAP to be refractory, while the T lymphocyte count, namely, the overall cellular immunity, was impaired in r-CAP patients, and increased TC levels could be beneficial to pneumonia recovery.
难治性社区获得性肺炎（r-CAP）已成为临床实践中的一个棘手问题，尤其是在新冠疫情之后，即使是传统定义的免疫功能正常的患者。在本研究中，我们旨在确定免疫功能正常的r-CAP患者的危险因素。这是一项单中心回顾性研究。我们总共收集了首都医科大学附属北京世纪坛医院2022年1月1日至2023年12月31日收治的82例一线抗生素治疗失败的r-CAP患者和82例一线抗生素治疗后康复的普通社区获得性肺炎（g-CAP）患者的临床资料，两组按1:1比例匹配。采用配对t检验、配对Wilcoxon检验、卡方检验或Fisher精确检验分析两组之间的差异（临床特征、外周血细胞计数、淋巴细胞亚群和常规实验室指标），并进行单因素和多因素逻辑回归分析以确定独立危险因素。建立了具有统计学意义的预测指标模型，并通过受试者工作特征（ROC）曲线进行验证。温暖季节、慢性阻塞性肺疾病史、从发病到入院的时间较长（T）、CD4 T淋巴细胞、CD8 T淋巴细胞和双阴性T（DNT）淋巴细胞的百分比更高，以及C反应蛋白（CRP）、低密度脂蛋白胆固醇（LDL-C）、血清钠离子（Na）和游离钙离子（FCa）水平更高被视为独立危险因素，而T淋巴细胞百分比（T%）和总胆固醇（TC）被确定为保护因素。使用上述所有因素的联合多因素模型被证明具有敏感性和特异性（AUC = 0.8711，P < 0.0001，R = 0.4235），因此优于各自的单因素模型。CD4 T%Lym、CD8 T%Lym和DNT%Lym升高、温暖季节、慢性阻塞性肺疾病史、T时间延长以及CRP、LDL-C、Na和FCa水平升高可能导致社区获得性肺炎难治，而r-CAP患者的T淋巴细胞计数即整体细胞免疫受损，TC水平升高可能有利于肺炎恢复。
