背景:严重流感,尤其是流感肺炎,每年造成大量死亡。一些患有严重流感的患者没有已知的危险因素。在这项研究中,我们调查了具有不同基本状况的甲型流感相关肺炎患者死亡的危险因素。我们还评估了肺炎严重程度评估工具在中国甲型流感相关肺炎住院患者中的功效。一起,这些结果可以为筛查方法提供基础,该方法提高了早期识别在临床实践中预后不良的危重患者的能力.
方法:这种单中心,回顾性病例对照研究纳入了152例成人重症流感患者,这些患者在6个流感季节以上.诊断和人口统计数据,以及临床数据,实验室发现,治疗方法,收集患者的30天和60天结果。有任何严重流感危险因素的患者被纳入高危人群,无已知危险因素的患者被纳入低危组.
结果:PSI,CURB-65和PIRO-CAP工具均低估了甲型流感相关肺炎住院患者的死亡率,这种低估在低风险患者中更为明显.D-二聚体(比值比[OR]=1.052,95%置信区间[CI]1.001-1.106,p=0.045)和直接胆红素(OR=1.143,95CI1.049-1.246,p=0.002)是甲型流感相关性肺炎患者死亡的独立危险因素。当与铁蛋白和D-二聚体联合使用时,受试者特征曲线下面积(AUCROC)为0.851(95CI0.780-0.922,p<0.001),PSI为0.840(95CI0.763-0.916,p<0.001)和0.829(95CI0.748-0.911,p<0.001),CURB-65和PIRO-CAP,分别,高于使用PSI获得的,仅CURB-65和PIRO-CAP。
结论:研究结果表明,目前使用的社区获得性肺炎(CAP)评分系统可能低估甲型流感相关肺炎死亡率的风险。D-二聚体是甲型流感相关性肺炎住院患者死亡的独立危险因素。D-二聚体与铁蛋白联合使用可以提高PSI的预测价值,CURB-65和PIRO-CAP用于甲型流感相关性肺炎患者的不良预后。
BACKGROUND: Severe influenza, especially influenza pneumonia, causes large numbers of deaths each year. Some patients who develop severe influenza have no known risk factors. In this study we investigated risk factors for mortality of patients with influenza A-related pneumonia who have different basic conditions. We also evaluated the power of pneumonia severity assessment tools in Chinese patients hospitalized with influenza A-related pneumonia. Together, these results could provide a basis for a screening method that has improved ability for the early identification of critical patients who will have poor prognoses in clinical practice.
METHODS: This single-center, retrospective
case-control study included 152 adult patients with severe influenza over six influenza seasons. Data for diagnoses and demographics, as well clinical data, laboratory findings, treatment methods, 30-day and 60-day outcomes of the patients were collected. Patients who had any of the risk factors for severe influenza were included in the high-risk group, and those that had no known risk factors were included in the low-risk group.
RESULTS: The PSI, CURB-65 and PIRO-CAP tools all underestimated the mortality rate of patients hospitalized with influenza A-related pneumonia, and this underestimate was more pronounced for low-risk patients. D-dimer (Odds ratio [OR] = 1.052, 95% confidence interval [CI] 1.001-1.106, p = 0.045) and direct bilirubin (OR = 1.143, 95%CI 1.049-1.246, p = 0.002) were independent risk factors for mortality of patients with influenza A-related pneumonia. When used in combination with
ferritin and D-dimer, the area under receiver operator characteristic curve (AUCROC) was 0.851 (95%CI 0.780-0.922, p < 0.001), 0.840 (95%CI 0.763-0.916, p < 0.001) and 0.829 (95%CI 0.748-0.911, p < 0.001) for PSI, CURB-65 and PIRO-CAP, respectively, which was higher than that obtained using PSI, CURB-65 and PIRO-CAP alone.
CONCLUSIONS: The findings demonstrate that currently used community-acquired pneumonia (CAP) scoring systems could underestimate the risk of influenza A-related pneumonia mortality. D-dimer was shown to be an independent risk factor of mortality for influenza A-related pneumonia in hospitalized patients, and a combination of D-dimer with
ferritin could improve the predictive value of PSI, CURB-65 and PIRO-CAP for adverse prognoses of patients with influenza A-related pneumonia.