Clinical characteristics and outcomes of severe community- and hospitalacquired pneumonia / 中国感染与化疗杂志

ABSTRACT

Objective To explore the clinical characteristics and prognostic factors of severe community-acquired pneumonia (SCAP) and severe hospital-acquired pneumonia (SHAP). Methods Clinical data of patients with severe pneumonia were reviewed and analyzed retrospectively. Multivariate logistic regression analysis was conducted to investigate the potential prognostic factors. Results A total of 70 SCAP cases and 110 SHAP cases were identified. SHAP patients showed higher proportion of surgical operation (P＜0.001), radiotherapy and/or chemotherapy (P=0.006) within 1 month, higher Charlson comorbidity index (P=0.001), and more malignancies (P＜0.001) than SCAP patients, but fewer failed organs (P=0.048), lower proportion of heart failure (P=0.003), and lower level of BNPmax (P=0.037) than SCAP. SHAP patients showed more total days of hospital stay than SCAP patients [33.0 (25.0, 43.3) days versus 14.0 (5.8, 28.3) days, P＜0.001 ], and higher 180-day mortality than SCAP patients (44.6％ versus 27.5％, P=0.047). The 180-day survival rate was significantly different between SCAP and SHAP patients (χ2=4.009, P=0.045). Multivariate analysis indicated that APACHE-II score (OR=20.449, P=0.002), cancer (OR=6.183, P=0.039), maximum D-dimer level (OR=13.841, P=0.008), and renal replacement therapy (RRT) (OR=19.456, P=0.003) were associated with the outcomes of SCAP patients. Two or more organ failure (OR=6.308, P=0.028), ventilator-associated pneumonia (OR=4.491, P=0.005), and RRT (OR=11.456, P=0.002) were associated with the outcomes of SHAP patients. Conclusions SCAP doesn't show significant difference from SHAP in in-hospital mortality or 30-day mortality. SHAP is associated with higher 180-day mortality than SCAP.