背景：社区获得性肺炎（CAP）在自身免疫性疾病（AID）诱导的免疫功能低下宿主（ICH）中的发病率高，预后差。然而,只有少数研究确定了这些患者的临床特征.我们的研究旨在探讨伴有AID诱发ICH的CAP患者的死亡率特征和预测因素。
方法：从2013年到2018年，共有94例CAP患者伴有AID诱发的ICH，入住中山医院急诊科，复旦大学,参加了这项研究。通过广义估计方程（GEEs）分析评估临床数据和重复预测因子的风险回归估计。使用开放队列方法将患者的结局分为生存或非生存组。
结果：发生AID诱发ICH的CAP患者的住院死亡率为60.64%。生存组和非生存组之间在临床症状和肺部图像方面没有发现显着差异。而肾功能不全和凝血功能障碍在非生存患者中所占比例较高(P<0.05)。非生存组无创通气（NIV）和有创机械通气（IMV）均较高（P<0.05）。通过多变量GEE分析，反复测量的中性粒细胞与淋巴细胞比率（NLR）的纵向指数（比值比[OR]=1.055，95％置信区间[95CI]1.025-1.086），乳酸脱氢酶（LDH）（OR=1.004，95CI1.002-1.006）和血清肌酐（sCr）（OR=1.018，95CI1.008-1.028），与较高的死亡风险相关。
结论：AID诱发ICH的CAP患者死亡率高。证明了NLR因素之间的显着关系，LDH,这些患者的sCr和死亡风险。
BACKGROUND: Community-acquired pneumonia (CAP) in autoimmune diseases (AID)-induced immunocompromised host (ICH) had a high incidence and poor prognosis. However, only a few studies had determined the clinical characteristics of these patients. Our study was to explore the characteristics and predictors of mortality in CAP patients accompanied with AID-induced ICH.
METHODS: From 2013 to 2018, a total of 94 CAP patients accompanied with AID-induced ICH, admitted to Emergency Department of Zhongshan Hospital, Fudan University, were enrolled in this study. Clinical data and the risk regression estimates of repeated predictors were evaluated by generalized estimating equations (GEEs) analysis. An open-cohort approach was used to classify patient\'s outcomes into the survival or non-survival group.
RESULTS: The hospital mortality of patients with CAP occurring in AID-induced ICH was 60.64%. No significant differences were found with respect to clinical symptoms and lung images between survival and non-survival groups, while renal insufficiency and dysfunction of coagulation had higher proportions in non-survival patients (P<0.05). Both noninvasive ventilation (NIV) and invasive mechanical ventilation (IMV) were performed more frequently in non-survival group (P< 0.05). By the multivariate GEEs analysis, the repeated measured longitudinal indices of neutrophil-to-lymphocyte ratio (NLR) (odds ratio [OR]=1.055, 95% confidence interval [95%CI] 1.025-1.086), lactate dehydrogenase (LDH) (OR=1.004, 95%CI 1.002-1.006) and serum creatinine (sCr) (OR=1.018, 95%CI 1.008-1.028), were associated with a higher risk of mortality.
CONCLUSIONS: The CAP patients in AID-induced ICH had a high mortality. A significant relationship was demonstrated between the factors of NLR, LDH, sCr and mortality risk in these patients.
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