DOI: 10.5061/dryad.cfxpnvx7r
title: The mortality risk factor of severe community-acquired pneumonia (SCAP) patients with Sepsis: a retrospective study

description: Objectives: Sepsis is one of the most common comorbidities in severe
 community-acquired pneumonia (SCAP) patients. We aimed to investigate the
 characteristics and mortality risk factors of SCAP patients hospitalized
 with Sepsis. Design: A retrospective, single-centre study. Setting: This
 study was conducted at a tertiary hospital in Southern China.
 Participants: A total of 119 patients with SCAP, aged 17 years or older,
 were treated in the Integrated intensive care unit from 1 January 2018 to
 30 December 2020. Interventions: none. Outcome: 180-day mortality was the
 primary outcome. Results: 119 patients were divided into the survivors (83
 patients,69.75%), and the non-survivors (36 patients,30.25%). There are
 more pronounced inflammatory responses and respiratory problems at the
 beginning of the disease in non-survivors, requiring stronger respiratory
 and circulatory support. The CURB-65 score was a better predictor of
 mortality than the PSI and APACHE2 scores, AUCs of CURB-65: OR 0.744,
 p&lt;0.005. For the entire treatment cycle, the non-survivors had a
 longer duration of persistent fever, required continuous and repeated
 airway intervention, and a longer duration of Vasopressor support
 (P&lt;0.001). SCAP with bacterial infection as the onset, or secondary
 bacterial infection had a poor prognosis (P=0.018). The non-survivors had
 more use of different types of antimicrobials (P&lt;0.05), because of
 Multidrug-resistant (MDR) organisms. And have faced more antifungal
 treatment failures (P=0.006). The mortality risk factors were comorbid
 with a duration of Vasopressors support, duration of persistent fever,
 age, numbers of antimicrobials for MDR organisms, CURB-65 score and
 duration of Neuromuscular Blocking Agents (NMBAs) (OR=1.234, OR=1.158,
 OR=1.084, OR=6.484, OR=3.386, OR=1.505, p&lt;0.005, respectively).
 Conclusion: Dynamic monitoring of the duration of patients' abnormal
 indicators can help predict the prognosis. Age≥65.5 years, fever duration
 ≥9.5 days, number of antimicrobials for MDR organisms ≥2 types, longer
 NMBAs and Vasopressors use, and higher CURB-65 score were mortality risk
 factors in SCAP-Sepsis patients.
description: <strong>Study
 design</strong> This was a single-centre retrospective
 analysis. Patients with
 the onset of CAP and conforming to Sepsis (infection +SOFA≥2) were
 included in the analysis,[8] with the outcome conforming to severe
 pneumonia. [11-12] The primary outcome was 180-day mortality. The baseline
 characteristics, clinical outcomes, and prognostic factors related to
 mortality were assessed. The written informed consent was waived due to
 the observational nature of the study. Ensure patients’
 anonymity. <strong>Subjects</strong>
 We retrospectively analyzed
 the clinical data of 119 patients with SCAP who were treated in the
 Integrated ICU of The First Affiliated Hospital of Soochow University (a
 comprehensive tertiary adult hospital) from 1 January 2018 to 30 December
 2020. The observation endpoint was 180-day mortality. Our inclusion
 criteria were: CAP whose outcome met the diagnosis of severe pneumonia and
 patients who met Sepsis criteria (SOFA≥2) at the onset. Our exclusion
 criteria were: patients Under 17 years of age. Patients who refused
 invasive resuscitation. Patients who have incomplete
 data. Patients
 whose outcome of treatment
 is not clear. Patients with unknown or mixed infection (more than one
 known infection source). Patients with Long-term Sanatoriums and Tend and
 Protect Hospitals treatment experience. Patients with transplantation,
 primary lung tumor, or advanced tumors at other sites. Presence of
 leukopenia or neutropenia (unless due to pneumonia). Adjuvant therapy for
 severe immunosuppression in human immunodeficiency virus-positive (HIV)
 patients (CD4 &lt;100). Patients with previous underlying pulmonary
 diseases (e.g., COPD, asthma, etc.) require long-term home oxygen therapy.
 Figure 1 shows the flow diagram of the study. 
 <strong>Data collection
 and definition</strong> Our study used an electronic medical record
 system to collect data for retrospective analysis. Our data were recorded
 by attending nurses and doctors at the time of patients’ presentation to
 the emergency department (ED). The demographic characteristics of each
 patient including comorbidities were reviewed thoroughly. We collected the
 patients' worst vital signs, laboratory results, ventilator support,
 and use of pressors within 24 hours of admission before initiation of ICU
 treatment. Score scales were used to calculate the relevant parameters of
 patients at admission, including APACHE2, SOFA, Pneumonia Severity Index
 (PSI), and CURB-65(a 5-point score based on confusion, urea, respiratory
 rate, blood pressure, and age ≥65). [13-16] (table2) Duration of fever,
 infection markers, respiratory management, and Sepsis medication were
 recorded during ICU treatment. Pathogenic microorganisms and subsequent
 antibiotic use of CAP were also collected.