The mortality risk factor of severe community-acquired pneumonia (SCAP) patients with Sepsis: a retrospective study

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 <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<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<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<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. strengths and limitations of this study We evaluated dynamic monitoring of the duration of patients’ abnormal indicators can help predict the prognosis. To the best of our knowledge, a very few studies had done a dynamic monitoring of the duration of patients’ abnormal indicators in the field of SCAP with Sepsis. The retrospective nature of the study was a limitation, statistical data including respiratory support in later treatment, can be further quantified. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The First Affiliated Hospital of Soochow University Ethics Committee (approval No.: 2022-120). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors