Clinical characteristics and prognosis of community-acquired pneumonia in autoimmune disease-induced immunocompromised host: A retrospective observational study

Abstract

BACKGROUND: Community-acquired pneumonia (CAP) in autoimmune diseases (AID)-induced immunocompromised host (ICH) had a high incidence and poor prognosis. However, only a few studies had determined the clinical characteristics of these patients. Our study was to explore the characteristics and predictors of mortality in CAP patients accompanied with AID-induced ICH. METHODS: From 2013 to 2018, a total of 94 CAP patients accompanied with AID-induced ICH, admitted to Emergency Department of Zhongshan Hospital, Fudan University, were enrolled in this study. Clinical data and the risk regression estimates of repeated predictors were evaluated by generalized estimating equations (GEEs) analysis. An open-cohort approach was used to classify patient's outcomes into the survival or non-survival group. RESULTS: The hospital mortality of patients with CAP occurring in AID-induced ICH was 60.64%. No significant differences were found with respect to clinical symptoms and lung images between survival and non-survival groups, while renal insufficiency and dysfunction of coagulation had higher proportions in non-survival patients (P<0.05). Both noninvasive ventilation (NIV) and invasive mechanical ventilation (IMV) were performed more frequently in non-survival group (P< 0.05). By the multivariate GEEs analysis, the repeated measured longitudinal indices of neutrophilto-lymphocyte ratio (NLR) (odds ratio [OR]=1.055, 95% confidence interval [95%CI] 1.025-1.086), lactate dehydrogenase (LDH) (OR=1.004, 95%CI 1.002-1.006) and serum creatinine (sCr) (OR=1.018, 95%CI 1.008-1.028), were associated with a higher risk of mortality. CONCLUSION: The CAP patients in AID-induced ICH had a high mortality. A signifi cant relationship was demonstrated between the factors of NLR, LDH, sCr and mortality risk in these patients.

Two new inflammatory markers related to the CURB-65 score for disease severity in patients with community-acquired pneumonia: The hypersensitive C-reactive protein to albumin ratio and fibrinogen to albumin ratio

“…Therefore, NLR and PLR are considered to be representative of the inflammatory status [ 17 , 18 ]. It has been reported that NLR and PLR may be alternative markers of CAP-related inflammation [ 19 , 20 , 21 ]. Moreover, NLR and PLR have been shown to be predictors of CAP severity [ 6 ].…”

Risk Factors for Severe Disease and Efficacy of Treatment in Patients Infected With COVID-19: A Systematic Review, Meta-Analysis, and Meta-Regression Analysis

“…In our analysis, LDH was the only marker that significantly predicted all three measured outcomes: ICU admission, ARDS and mortality. LDH is released from cells upon damage to their cytoplasmic membrane, and is not only a metabolic but also an immune surveillance prognostic biomarker [22,23]. LDH increases the production of lactate, which leads to enhancement of immune-suppressive cells and inhibition of cytolytic cells [24].…”

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“…[10] Elevated APACHE IV score indicates an association between critical condition and mortality, and APACHE score has been found as a risk factor for the prognosis of different critical populations in ICU. [44,45] Older patients who require prolonged ventilation have a higher risk of mortality and heavier burdens of treatment. [24,46] Also, for patients older than 70 years, they have been found to have an increased risk of death due to sepsis.…”