ZONG Qiu 1 # , LI Huifang 2 # , MOU Yong 1 , WANG Qi 1 , WANG Yi 1 , WANG Tao 1 , YU Muqing 1 , XU Yongjian 1 , ZHOU Min 1
  • 1. Department of Respiratory Diseases and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P. R. China;
  • 2. Department of Respiratory Diseases and Critical Care Medicine, Huangzhou District People's Hospital, Huanggang, Hubei 438000, P. R. China;
ZHOU Min, Email: minzhou@tjh.tjmu.edu.cn
Community acquired pneumonia; Lactate dehydrogenase; High-density lipoprotein; CURB65; Prediction method
10.7507/1671-6205.202010017
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Objective To explore the independent factors related to clinical severe events in community acquired pneumonia patients and to find out a simple, effective and more accurate prediction method.Methods Consecutive patients admitted to our hospital from August 2018 to July 2019 were enrolled in this retrospective study. The endpoint was the occurrence of severe events defined as a condition as follows intensive care unit admission, the need for mechanical ventilation or vasoactive drugs, or 30-day mortality during hospitalization. The patients were divided into severe event group and non-severe event group, and general clinical data were compared between two groups. Multivariate logistic regression analysis was performed to identify the independent predictors of adverse outcomes. Receiver operating characteristic (ROC) curve was constructed to calculate and compare the area under curve (AUC) of different prediction methods.Results A total of 410 patients were enrolled, 96 (23.4%) of whom experienced clinical severe events. Age (OR: 1.035, 95%CI: 1.012 - 1.059, P=0.003), high-density lipoprotein (OR: 0.266, 95%CI: 0.088 - 0.802, P=0.019) and lactate dehydrogenase (OR: 1.006, 95%CI: 1.004 - 1.059, P<0.001) levels on admission were independent factors associated with clinical severe events in CAP patients. The AUCs in the prediction of clinical severe events were 0.744 (95%CI: 0.699 - 0.785, P=0.028) and 0.814 (95%CI: 0.772 - 0.850, P=0.025) for CURB65 and PSI respectively. CURB65-LH, combining CURB65, HDL and LDH simultaneously, had the largest AUC of 0.843 (95%CI: 0.804 - 0.876, P=0.022) among these prediction methods and its sensitivity (69.8%) and specificity (81.5%) were higher than that of CURB65 (61.5% and 76.1%) respectively.Conclusion CURB65-LH is a simple, effective and more accurate prediction method of clinical severe events in CAP patients, which not only has higher sensitivity and specificity, but also significantly improves the predictive value when compared with CURB65.

Citation： ZONG Qiu, LI Huifang, MOU Yong, WANG Qi, WANG Yi, WANG Tao, YU Muqing, XU Yongjian, ZHOU Min. Prediction methods of clinical severe events in patients with community acquired pneumonia. Chinese Journal of Respiratory and Critical Care Medicine, 2021, 20(3): 153-158. doi: 10.7507/1671-6205.202010017 Copy

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