摘要
目的 探讨社区获得性肺炎(community-acquired pneumonia,CAP)合并糖尿病(diabetes mellitus,DM)患者的临床特征和住院期间死亡的危险因素。方法 回顾性收集昆明医科大学第二附属医院2018年1月至2022年1月住院治疗的566例CAP患者资料,根据患者是否合并糖尿病分为单纯CAP组(n=478),CAP合并糖尿病(CAP+DM)组(n=88),再根据患者住院期间是否死亡将CAP+DM组(n=88)分为存活组(n=69)和死亡组(n=19)。分别比较不同分组患者的临床资料和入院时的实验室化验指标,采用Cox回归分析筛选CAP+DM组患者住院期间死亡的危险因素,绘制受试者工作特征(receiver operating characteristic,ROC)曲线评估危险因素对住院期间死亡的预测价值。结果 与单纯CAP组比较,CAP+DM组患者在年龄、合并高血压、冠心病、CURB-65评分、中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)、C反应蛋白(C-reactive protein,CRP)、降钙素原(procalcitonin,PCT)、白蛋白(albumin,ALB)、前白蛋白(prealbumin,PA)、葡萄糖(glucose,GLU)、血清钾(potassium,K)、钙(calcium,Ca)、磷(phosphorus,P)、镁(magnesium,Mg)、乳酸(lactic acid,Lac),无创通气时间、入住ICU率及病死率比较上,差异有统计学意义(P <0.05);与存活组比较,死亡组患者在CURB-65评分、NLR、CRP、PCT、GIU、ALB、PA、血清铁(iron,Fe)、Ca、无创通气时间、入住ICU率比较上,差异有统计学意义(P <0.05)。Cox回归分析显示,NLR水平升高、PA水平下降是CAP合并糖尿病患者住院期间死亡的危险因素(P <0.05)。PA截断值为91 mg/L时,预测合并糖尿病的CAP患者住院期间死亡的曲线下面积(area under curve,AUC)、灵敏度和特异度分别为0.849,84.2%、81.2%。结论 CAP合并糖尿病的患者较单纯的CAP患者病情更严重,预后更差,PA对这类患者的预后具有良好的预测价值,应早期检测并积极干预,以降低患者的住院病死率。
Objective To explore the clinical characteristics and risk factors of death during hospitalization in patients with community-acquired pneumonia(CAP)complicated with diabetes mellitus(DM).Methods A retrospective analysis was performed on 566 patients with CAP hospitalized in the Second Affiliated Hospital of Kunming Medical University from January 2018 to January 2022.The patients were divided into simple CAP group(n=478)and CAP combined with diabetes(CAP+DM)group(n=88)according to whether they had diabetes,and then CAP+DM group(n=88)was divided into survival group(n=69)and death group(n=19)according to whether the patients died during hospitalization.The clinical data and laboratory test indicators of patients in different groups were compared.Cox regression analysis was used to screen the risk factors of death during hospitalization in the CAP+DM group.Receiver operating characteristic(ROC)curve was plotted to evaluate the predictive value of independent risk factors on hospitalization death.Results Compared with the simple CAP group,the CAP+DM group had significant differences in age,concomitant hypertension,coronary heart disease,CURB-65 score,neutrophil to lymphocyte ratio(NLR),C-reactive protein(CRP),procalcitonin(PCT),albumin(ALB),prealbumin(PA),glucose(GLU),serum potassium(K),calcium(Ca),phosphorus(P),magnesium(Mg),lactic acid(Lac),non-invasive ventilation time,ICU occupancy rate and mortality rate(P<0.05);Compared with the survival group,there were statistically significant differences in CURB-65 score,NLR,CRP,PCT,GIU,ALB,PA,serum iron(Fe),Ca,non-invasive ventilation time,and ICU admission rate among the death group patients(P<0.05).Cox regression analysis showed that the increase of NLR level and the decrease in PA level were the risk factors for in-hospital death in patients with CAP complicated with diabetes(P<0.05).When the PA cutoff value was 91 mg/L,the AUC,sensitivity,and specificity for predicting in-hospital death of CAP patients with diabetes were 0.849,84.2%and 81.2%,respectively.Conclusion Pa
作者
马建芳
黄晓玲
李艳华
马狄
袁开芬
Jianfang MA;Xiaoling HUANG;Yanhua LI;Di MA;Kaifen YUAN(Dept.of General Medicine,The 2nd Affiliated Hospital of Kunming Medical University,Kunming Yunnan 650101,China)
出处
《昆明医科大学学报》
CAS
2024年第2期123-130,共8页
Journal of Kunming Medical University
基金
昆明医科大学硕士研究生创新基金资助项目(2023S329)。
关键词
社区获得性肺炎
糖尿病
临床特征
病死率
前白蛋白
Community-acquired pneumonia
Diabetes mellitus
Clinical features
Mortality rate
Prealbumin
