Analysis of clinical characteristics and prognostic factors in patients with community-acquired pneumonia complicated with bronchiectasis_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

ZHANG Huijuan ¹ , HAN Xiudi ¹ ,  LIU Xuedong ¹ ,  CAO Bin ² , LI Hui ² , WANG Yimin ² , LI Lijuan ² , CUI Xiaojing ² , CHEN Liang ³ , ZHOU Fei ⁴ , XUE Chunxue ⁴ , LI Yanli ⁴ , XIAO Ying ⁴ , LIU Meng ⁴ , ZHANG Chunxiao ⁵ , XING Xiqian ⁶ , SUO Lijun ⁷ , LIU Bo ⁷ , WANG Jinxiang ⁸ , YU Guohua ⁹ , WANG Guangqiang ¹⁰ , YAO Xuexin ¹¹ , Yu Hongxia ¹² , WANG Lei ¹³ , ZHU Xiaoli ¹⁴ , and for the CAP-China network

1. Department of Pulmonary and Critical Care Medicine. Qingdao Municipal Hospital, Qingdao, Shandong 266011, P. R. China;
2. Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Beijing 100029, P. R. China;
3. Department of Infectious Diseases, Beijing Jishuitan Hospital, Fourth Clinical Medical College of Peking University, Beijing 100096, P. R. China;
4. Department of Infectious and Clinical Microbiology. Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing 100043, P. R. China;
5. Pneumology Department, Beijing Huimin Hospital, Beijing 100053, P. R. China;
6. Department of Pulmonary and Critical Care Medicine. Yan'an Hospital Affiliated to Kunming Medical College, Kunming, Yunnan 650051, P. R. China;
7. Department of Pulmonary and Critical Care Medicine, Linzi District People's Hospital, Zibo, Shandong 255000, P. R. China;
8. Department of Pulmonary and Critical Care Medicine, Luhe Hospital Affiliated to Capital Medical University, Beijing 101149, P. R. China;
9. Department of Pulmonary and Critical Care Medicine, Weifang Second People's Hospital, Weifang, Shandong 261000, P. R. China;
10. Pneumology Department, Qilu Hospital of Shandong University, Qingdao, Shandong 266011, P. R. China;
11. Pneumology Department, The Second Hospital of Beijing Armed Police Corps, Beijing 100045, P. R. China;
12. Department of Infectious Diseases, Yantai Yuhuangding Hospital, Yantai, Shandong 264000, P. R. China;
13. Pneumology Department, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Rizhao, Shandong 267800, P. R. China;
14. Department of Poisoning and Occupational Diseases, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing 100043, P. R. China;

Corresponding author：

LIU Xuedong, Email: xuedongliu@263.net; CAO Bin, Email: caobin_ben@163.com

Keywords：

Community acquired pneumonia; bronchiectasis; clinical characteristics; prognosis; risk factor

DOI：

10.7507/1671-6205.202103036

Video：

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Objectives To analyze the effect of bronchiectasis (BE) on the clinical characteristics and prognosis of hospitalized patients with community acquired pneumonia (CAP), and to explore the independent risk factors affecting the 30-day mortality. Methods A national multi-center retrospective study based on the CAP-China network platform. The clinical data of 6056 patients with CAP who were hospitalized in 13 tertiary teaching hospitals in Beijing, Shandong and Yunnan from January 1, 2014 to December 31, 2014 were collected. To compare the differences in clinical characteristics, etiological distribution and treatment prognosis of patients with CAP with bronchiectasis (BE-CAP) and patients without bronchiectasis (non-BE-CAP). Logistic regression analysis was performed to analyze independent risk factors affecting 30-day mortality in hospitalized patients with BE-CAP. Results In the final analysis, 5880 CAP patients were included, and BE-CAP patients accounted for 10.8% (637/5880). Compared with non-BE-CAP patients, more BE-CAP patients were women, and a higher proportion of patients had chronic obstructive pulmonary disease, bronchial asthma, previous history of glucocorticoid inhalation, and a history of CAP within 1 year. BE-CAP patients had more dyspnea and cyanosis, lower arterial partial pressure of oxygen, longer median time to clinical stability (6 d vs. 4 d, P<0.001), and the incidence of respiratory failure was significantly higher than that of non-BE-CAP patients (27.8% vs. 19.7%, P<0.001). Pseudomonas aeruginosa is the most common bacterial infection in BE-CAP patients. Comorbid bronchiectasis has no significant effect on disease severity, total length of hospital stay, and mortality in CAP patients. The 30-day mortality rate of BE-CAP patients was 2.2%. Logistic regression analysis showed that initial treatment failure [odds ratio (OR) 6.675, 95% confidence interval (CI) 4.235-10.523, P<0.001], respiratory failure (OR 5.548, 95%CI 3.681-8.363, P<0.001), blood urea nitrogen>7.0 mmol/L (OR 2.490, 95%CI 1.625-3.815, P<0.001), albumin<35.0 g/L (OR 1.647, 95%CI 1.073-2.529, P=0.022) and CURB-65 score (OR 1.691, 95%CI 1.341-2.133, P<0.001) were independent risk factors for 30-day mortality in BE-CAP patients. Conclusions BE-CAP patients have more serious hypoxia symptoms and higher incidence of respiratory failure. For BE-CAP patients with failure of initial treatment, complicated with respiratory failure, blood urea nitrogen>7.0 mmol/L, and albumin<35.0 g/L, treatment evaluation should be performed in time to reduce the mortality rate.

Citation： ZHANG Huijuan, HAN Xiudi, LIU Xuedong, CAO Bin, LI Hui, WANG Yimin, LI Lijuan, CUI Xiaojing, CHEN Liang, ZHOU Fei, XUE Chunxue, LI Yanli, XIAO Ying, LIU Meng, ZHANG Chunxiao, XING Xiqian, SUO Lijun, LIU Bo, WANG Jinxiang, YU Guohua, WANG Guangqiang, YAO Xuexin, Yu Hongxia, WANG Lei, ZHU Xiaoli, and for the CAP-China network. Analysis of clinical characteristics and prognostic factors in patients with community-acquired pneumonia complicated with bronchiectasis. Chinese Journal of Respiratory and Critical Care Medicine, 2022, 21(4): 251-259. doi: 10.7507/1671-6205.202103036 Copy

1.	Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet, 2020, 396(10258): 1204-1222.
2.	File TM Jr, Marrie TJ. Burden of community-acquired pneumonia in North American adults. Postgrad Med, 2010, 122(2): 130-141.
3.	Hayes BH, Haberling DL, Kennedy JL, et al. Burden of pneumonia-associated hospitalizations: United States, 2001-2014. Chest, 2018, 153(2): 427-437.
4.	Kolditz M, Tesch F, Mocke L, et al. Burden and risk factors of ambulatory or hospitalized CAP: A population based cohort study. Respir Med, 2016, 121: 32-38.
5.	Chen L, Zhou F, Li H, et al. Disease characteristics and management of hospitalised adolescents and adults with community-acquired pneumonia in China: a retrospective multicentre survey. BMJ Open, 2018, 8(2): e018709.
6.	National Center for Health Statistics(US). Health, United States, 2012: with special feature on emergency care. Hyattsville, MD: National Center for Health Statistics, 2013, 297-299. Bookshelf ID: NBK148940.
7.	Hill AT, Sullivan AL, Chalmers JD, et al. British Thoracic Society Guideline for Bronchiectasis in Adults. Thorax, 2019, 74(Suppl 1): 1-69.
8.	Polverino E, Goeminne PC, McDonnell MJ, et al. European Respiratory Society Guidelines for the Management of Adult Bronchiectasis. Eur Respir J, 2017, 50(3): 1700629.
9.	Quint JK, Millett ER, Joshi M, et al. Changes in the incidence, prevalence and mortality of bronchiectasis in the UK from 2004 to 2013: a population-based cohort study. Eur Respir J, 2016, 47(1): 186-193.
10.	Weycker D, Hansen GL, Seifer FD. Prevalence and incidence of noncystic fibrosis bronchiectasis among US adults in 2013. Chron Respir Dis, 2017, 14(4): 377-384.
11.	Polverino E, Cilloniz C, Menendez R, et al. Microbiology and outcomes of community acquired pneumonia in non cystic-fibrosis bronchiectasis patients. J Infect, 2015, 71(1): 28-36.
12.	中华医学会呼吸病学分会. 中国成人社区获得性肺炎诊断和治疗指南(2016 年版). 中华结核和呼吸杂志, 2016, 39(4): 253-279.
13.	Jiang W, Wu M, Zhou J, et al. Etiologic spectrum and occurrence of coinfections in children hospitalized with community-acquired pneumonia. BMC Infect Dis, 2017, 17(1): 787.
14.	Fine MJ, Auble TE, Yealy DM, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med, 1997, 336(4): 243-250.
15.	Lim WS, van der Eerden MM, Laing R, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax, 2003, 58(5): 377-382.
16.	Menéndez R, Torres A, Rodríguez de Castro F, et al. Reaching stability in community acquired pneumonia: the effects of the severity of disease, treatment, and the characteristics of patients. Clin Infect Dis, 2004, 39(12): 1783-1790.
17.	Guidelines for the Management of Adults with Hospital-acquired, Ventilator-associated, and Healthcare-associated Pneumonia. Am J Respir Crit Care Med, 2005, 171(4): 388-416.
18.	Metlay JP, Waterer GW, Long AC, et al. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med, 2019, 200(7): e45-e67.
19.	Sanchez-Muñoz G, López-de-Andrés A, Hernández-Barrera V, et al. Hospitalizations for community-acquired and non-ventilator-associated hospital-acquired pneumonia in Spain: influence of the presence of bronchiectasis. A retrospective database study. J Clin Med, 2020, 9(8): 2399.
20.	周玉民, 王辰, 姚婉贞, 等. 我国 7 省市城区 40 岁及以上居民支气管扩张症的患病情况及危险因素调查. 中华内科杂志, 2013, 52(5): 379-382.
21.	张玉强. 辽宁某三甲医院 2012 年-2016 年呼吸内科住院患者疾病构成调查. 中国病案, 2018, 19(11): 48-51.
22.	郑燕婵, 王嘉玲, 刘雯雯, 等. 大型综合性医院呼吸内科 2006—2017 年住院因素的帕累托图分析. 广东医学, 2018, 39(16): 2450-2454.
23.	Girón RM, de Gracia Roldán J, Olveira C, et al. Sex bias in diagnostic delay in bronchiectasis: An analysis of the Spanish Historical Registry of Bronchiectasis. Chron Respir Dis, 2017, 14(4): 360-369.
24.	Seifer FD, Hansen G, Weycker D. Health-care utilization and expenditures among patients with comorbid bronchiectasis and chronic obstructive pulm-onary disease in US clinical practice. Chron Respir Dis, 2019, 1479973119839961: 1479973119839961.
25.	Martinez-Garcia MA, Miravitlles M. Bronchiectasis in COPD patients: more than a comorbidity?. Int J Chron Obstruct Pulmon Dis, 2017, 12: 1401-1411.
26.	Voglis S, Quinn K, Tullis E, et al. Human neutrophil peptides and phagocytic deficiency inbronchiectatic lungs. Am J Respir Crit Care Med, 2009, 180(2): 159-166.
27.	Araújo D, Shteinberg M, Aliberti S, et al. The independent contribution of Pseudomonas aeruginosa infection to long-term clinical outcomes in bronchiectasis. Eur Respir J, 2018, 51(2): 1701953.
28.	杨丽青, 杨小东, 杨凌婧, 等. 支气管扩张患者急性加重危险因素分析. 中国呼吸与危重监护杂志, 2020, 19(6): 543-547.
29.	Cillóniz C, Gabarrús A, Ferrer M, et al. Community-acquired pneumonia due to multidrug and non-multidrug-resistant Pseudomonas aeruginosa. Chest, 2016, 150(2): 415-425.
30.	Lewis PO. Risk Factor Evaluation for Methicillin-resistant Staphylococcus-aureus and Pseudomonas aeruginosa in community-acquired pneumonia. Ann Pharmacother, 2021, 55(1): 36-43.
31.	Menéndez R, Torres A, Zalacaín R, et al. Risk factors of treatment failure in community acquired pneumonia: implications for disease outcome. Thorax, 2004, 59(11): 960-965.
32.	Rosón B, Carratalà J, Fernández-Sabé N, et al. Causes and factors associated with early failure in hospitalized patients with community-acquired pneumonia. Arch Intern Med, 2004, 164(5): 502-508.
33.	Sialer S, Liapikou A, Torres A. What is the best approach to the nonresponding patient with community-acquired pneumonia?. Infect Dis Clin North Am, 2013, 27(1): 189-203.
34.	Aliberti S, Amir A, Peyrani P, et al. Incidence, etiology, timing, and risk factors for clinical failure in hospitalized patients with community-acquired pneumonia. Chest, 2008, 134(5): 955-962.
35.	Garcia-Vidal C, Carratalà J. Early and late treatment failure in community-acquired pneumonia. Semin Respir Crit Care Med, 2009, 30(2): 154-160.
36.	Genné D, Sommer R, Kaiser L, et al. Analysis of factors that contribute to treatment failure in patients with community-acquired pneumonia. Eur J Clin Microbiol Infect Dis, 2006, 25(3): 159-166.
37.	Fisher K, Trupka T, Micek ST, et al. A prospective one-year microbiologic survey of combined pneumonia and respiratory failure. Surg Infect (Larchmt), 2017, 18(7): 827-833.
38.	Kohno S, Seki M, Takehara K, et al. Prediction of requirement for mechanical ventilation in community-acquired pneumonia with acute respiratory failure: a multicenter prospective study. Respiration, 2013, 85(1): 27-35.
39.	Hadda V, Chawla G, Tiwari P, et al. Noninvasive ventilation for acute respiratory failure due to noncystic fibrosis bronchiectasis. Indian J Crit Care Med, 2018, 22(5): 326-331.
40.	Ferrer M, Travierso C, Cilloniz C, et al. Severe community-acquired pneumonia: characteristics and prognostic factors in ventilated and non-ventilated patients. PLoS One, 2018, 13(1): e0191721.
41.	Ugajin M, Yamaki K, Iwamura N, et al. Blood urea nitrogen to serum albumin ratio independently predicts mortality and severity of community-acquired pneumonia. Int J Gen Med, 2012, 5: 583-589.
42.	Adnan M, Hashmat N, Latif M, et al. Hypoalbuminemia predicts intensive care need among adult inpatients with community acquired pneumonia: a cross sectional study. J Infect Dev Ctries, 2018, 12(8): 636-641.
43.	Cheng A, Hu L, Wang Y, et al. Diagnostic performance of initial blood urea nitrogen combined with D-dimer levels for predicting in-hospital mortality in COVID-19 patients. Int J Antimicrob Agents, 2020, 56(3): 106110.
44.	Tamion F. Albumin in sepsis. Ann Fr Anesth Reanim, 2010, 29(9): 629-634.
45.	Viasus D, Garcia-Vidal C, Simonetti A, et al. Prognostic value of serum albumin levels in hospitalized adults with community-acquired pneumonia. J Infect, 2013, 66(5): 415-423.
46.	Meziani F, Kremer H, Tesse A, et al. Human serum albumin improves arterial dysfunction during early resuscitation in mouse endotoxic model via reduced oxidative and nitrosative stresses. Am J Pathol, 2007, 171(6): 1753-1761.
47.	Caironi P, Tognoni G, Masson S, et al. Albumin replacement in patients withsevere sepsis or septic shock. N Engl J Med, 2014, 370(15): 1412-1421.

1. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet, 2020, 396(10258): 1204-1222.
2. File TM Jr, Marrie TJ. Burden of community-acquired pneumonia in North American adults. Postgrad Med, 2010, 122(2): 130-141.
3. Hayes BH, Haberling DL, Kennedy JL, et al. Burden of pneumonia-associated hospitalizations: United States, 2001-2014. Chest, 2018, 153(2): 427-437.
4. Kolditz M, Tesch F, Mocke L, et al. Burden and risk factors of ambulatory or hospitalized CAP: A population based cohort study. Respir Med, 2016, 121: 32-38.
5. Chen L, Zhou F, Li H, et al. Disease characteristics and management of hospitalised adolescents and adults with community-acquired pneumonia in China: a retrospective multicentre survey. BMJ Open, 2018, 8(2): e018709.
6. National Center for Health Statistics(US). Health, United States, 2012: with special feature on emergency care. Hyattsville, MD: National Center for Health Statistics, 2013, 297-299. Bookshelf ID: NBK148940.
7. Hill AT, Sullivan AL, Chalmers JD, et al. British Thoracic Society Guideline for Bronchiectasis in Adults. Thorax, 2019, 74(Suppl 1): 1-69.
8. Polverino E, Goeminne PC, McDonnell MJ, et al. European Respiratory Society Guidelines for the Management of Adult Bronchiectasis. Eur Respir J, 2017, 50(3): 1700629.
9. Quint JK, Millett ER, Joshi M, et al. Changes in the incidence, prevalence and mortality of bronchiectasis in the UK from 2004 to 2013: a population-based cohort study. Eur Respir J, 2016, 47(1): 186-193.
10. Weycker D, Hansen GL, Seifer FD. Prevalence and incidence of noncystic fibrosis bronchiectasis among US adults in 2013. Chron Respir Dis, 2017, 14(4): 377-384.
11. Polverino E, Cilloniz C, Menendez R, et al. Microbiology and outcomes of community acquired pneumonia in non cystic-fibrosis bronchiectasis patients. J Infect, 2015, 71(1): 28-36.
12. 中华医学会呼吸病学分会. 中国成人社区获得性肺炎诊断和治疗指南(2016 年版). 中华结核和呼吸杂志, 2016, 39(4): 253-279.
13. Jiang W, Wu M, Zhou J, et al. Etiologic spectrum and occurrence of coinfections in children hospitalized with community-acquired pneumonia. BMC Infect Dis, 2017, 17(1): 787.
14. Fine MJ, Auble TE, Yealy DM, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med, 1997, 336(4): 243-250.
15. Lim WS, van der Eerden MM, Laing R, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax, 2003, 58(5): 377-382.
16. Menéndez R, Torres A, Rodríguez de Castro F, et al. Reaching stability in community acquired pneumonia: the effects of the severity of disease, treatment, and the characteristics of patients. Clin Infect Dis, 2004, 39(12): 1783-1790.
17. Guidelines for the Management of Adults with Hospital-acquired, Ventilator-associated, and Healthcare-associated Pneumonia. Am J Respir Crit Care Med, 2005, 171(4): 388-416.
18. Metlay JP, Waterer GW, Long AC, et al. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med, 2019, 200(7): e45-e67.
19. Sanchez-Muñoz G, López-de-Andrés A, Hernández-Barrera V, et al. Hospitalizations for community-acquired and non-ventilator-associated hospital-acquired pneumonia in Spain: influence of the presence of bronchiectasis. A retrospective database study. J Clin Med, 2020, 9(8): 2399.
20. 周玉民, 王辰, 姚婉贞, 等. 我国 7 省市城区 40 岁及以上居民支气管扩张症的患病情况及危险因素调查. 中华内科杂志, 2013, 52(5): 379-382.
21. 张玉强. 辽宁某三甲医院 2012 年-2016 年呼吸内科住院患者疾病构成调查. 中国病案, 2018, 19(11): 48-51.
22. 郑燕婵, 王嘉玲, 刘雯雯, 等. 大型综合性医院呼吸内科 2006—2017 年住院因素的帕累托图分析. 广东医学, 2018, 39(16): 2450-2454.
23. Girón RM, de Gracia Roldán J, Olveira C, et al. Sex bias in diagnostic delay in bronchiectasis: An analysis of the Spanish Historical Registry of Bronchiectasis. Chron Respir Dis, 2017, 14(4): 360-369.
24. Seifer FD, Hansen G, Weycker D. Health-care utilization and expenditures among patients with comorbid bronchiectasis and chronic obstructive pulm-onary disease in US clinical practice. Chron Respir Dis, 2019, 1479973119839961: 1479973119839961.
25. Martinez-Garcia MA, Miravitlles M. Bronchiectasis in COPD patients: more than a comorbidity?. Int J Chron Obstruct Pulmon Dis, 2017, 12: 1401-1411.
26. Voglis S, Quinn K, Tullis E, et al. Human neutrophil peptides and phagocytic deficiency inbronchiectatic lungs. Am J Respir Crit Care Med, 2009, 180(2): 159-166.
27. Araújo D, Shteinberg M, Aliberti S, et al. The independent contribution of Pseudomonas aeruginosa infection to long-term clinical outcomes in bronchiectasis. Eur Respir J, 2018, 51(2): 1701953.
28. 杨丽青, 杨小东, 杨凌婧, 等. 支气管扩张患者急性加重危险因素分析. 中国呼吸与危重监护杂志, 2020, 19(6): 543-547.
29. Cillóniz C, Gabarrús A, Ferrer M, et al. Community-acquired pneumonia due to multidrug and non-multidrug-resistant Pseudomonas aeruginosa. Chest, 2016, 150(2): 415-425.
30. Lewis PO. Risk Factor Evaluation for Methicillin-resistant Staphylococcus-aureus and Pseudomonas aeruginosa in community-acquired pneumonia. Ann Pharmacother, 2021, 55(1): 36-43.
31. Menéndez R, Torres A, Zalacaín R, et al. Risk factors of treatment failure in community acquired pneumonia: implications for disease outcome. Thorax, 2004, 59(11): 960-965.
32. Rosón B, Carratalà J, Fernández-Sabé N, et al. Causes and factors associated with early failure in hospitalized patients with community-acquired pneumonia. Arch Intern Med, 2004, 164(5): 502-508.
33. Sialer S, Liapikou A, Torres A. What is the best approach to the nonresponding patient with community-acquired pneumonia?. Infect Dis Clin North Am, 2013, 27(1): 189-203.
34. Aliberti S, Amir A, Peyrani P, et al. Incidence, etiology, timing, and risk factors for clinical failure in hospitalized patients with community-acquired pneumonia. Chest, 2008, 134(5): 955-962.
35. Garcia-Vidal C, Carratalà J. Early and late treatment failure in community-acquired pneumonia. Semin Respir Crit Care Med, 2009, 30(2): 154-160.
36. Genné D, Sommer R, Kaiser L, et al. Analysis of factors that contribute to treatment failure in patients with community-acquired pneumonia. Eur J Clin Microbiol Infect Dis, 2006, 25(3): 159-166.
37. Fisher K, Trupka T, Micek ST, et al. A prospective one-year microbiologic survey of combined pneumonia and respiratory failure. Surg Infect (Larchmt), 2017, 18(7): 827-833.
38. Kohno S, Seki M, Takehara K, et al. Prediction of requirement for mechanical ventilation in community-acquired pneumonia with acute respiratory failure: a multicenter prospective study. Respiration, 2013, 85(1): 27-35.
39. Hadda V, Chawla G, Tiwari P, et al. Noninvasive ventilation for acute respiratory failure due to noncystic fibrosis bronchiectasis. Indian J Crit Care Med, 2018, 22(5): 326-331.
40. Ferrer M, Travierso C, Cilloniz C, et al. Severe community-acquired pneumonia: characteristics and prognostic factors in ventilated and non-ventilated patients. PLoS One, 2018, 13(1): e0191721.
41. Ugajin M, Yamaki K, Iwamura N, et al. Blood urea nitrogen to serum albumin ratio independently predicts mortality and severity of community-acquired pneumonia. Int J Gen Med, 2012, 5: 583-589.
42. Adnan M, Hashmat N, Latif M, et al. Hypoalbuminemia predicts intensive care need among adult inpatients with community acquired pneumonia: a cross sectional study. J Infect Dev Ctries, 2018, 12(8): 636-641.
43. Cheng A, Hu L, Wang Y, et al. Diagnostic performance of initial blood urea nitrogen combined with D-dimer levels for predicting in-hospital mortality in COVID-19 patients. Int J Antimicrob Agents, 2020, 56(3): 106110.
44. Tamion F. Albumin in sepsis. Ann Fr Anesth Reanim, 2010, 29(9): 629-634.
45. Viasus D, Garcia-Vidal C, Simonetti A, et al. Prognostic value of serum albumin levels in hospitalized adults with community-acquired pneumonia. J Infect, 2013, 66(5): 415-423.
46. Meziani F, Kremer H, Tesse A, et al. Human serum albumin improves arterial dysfunction during early resuscitation in mouse endotoxic model via reduced oxidative and nitrosative stresses. Am J Pathol, 2007, 171(6): 1753-1761.
47. Caironi P, Tognoni G, Masson S, et al. Albumin replacement in patients withsevere sepsis or septic shock. N Engl J Med, 2014, 370(15): 1412-1421.

Chinese Journal of Respiratory and Critical Care Medicine

Analysis of clinical characteristics and prognostic factors in patients with community-acquired pneumonia complicated with bronchiectasis

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