Objective To investigate the prognostic factors of lower respiratory tract infection ( LRTI ) among hospitalized patients.Methods A total of 178 hospitalized patients with LRTI were retrospectively reviewed and divided in two groups according to the outcomes of the disease, namely the improved group ( 152 cases ) and the death group ( 26 cases ).Demographic data.co - morbidities, and baseline clinical and laboratory data on admission were compared hetween the two groups using variance analysis ( quantitative variable ) or chi - square test ( qualitative variable ).Furthermore , multivariable logistic regression was used to identify independent risk factors.Results Univariate analysis revealed that indicators significantly different between the improved group and the death group included : history of LRTI episode within one year, history of invasive ventilator use within one year, family history of asthma, increase of peripheral white blood cell, decrease of hemoglobin , increase of aterial partial pressure of carbon dioxide ( PaCO2 ), decrease of arterial pH, decreases of serum concentrations of Na+.Cl- , aspartate aminotransferase ( AST ), total protein, albumin, blood urea nitrogen ( Bun ), creatinine ( Cr), positive sputum culture and positive occult blood in stools ( P ＜ 0.05 ).Multivariable logistic regression revealed statistical significance for factors including history of LRTI episode within one year, history of invasive ventilator use within one year, family history of asthma, decrease of arterial pH, and positive occult blood in stools ( P ＜ 0.05 ); also in the multivariable analysis, hypoalbuminemia showed a statistical cut - off value ( P = 0.057 ).Conclusion History of LRTI episode within one year, history of invasive ventilator use within one year, family history of asthma, decrease of arterial pH, and positive occult blood in stools are among the independent risk factors of LRTI death.Hypoalbuminemia may influence the prognosis of the patients.Active treatment should be delivered to improve the prognosis of LRTI patients with high risk factors.%目的 探讨住院下呼吸道感染(LRTI)患者的预后影响因素.方法 回顾性分析呼吸内科住院的178例LRTI患者.按疾病转归分为治疗好转组(152例)和死亡组(26例).对两组患者的一般情况、主要病史和相关实验室检查等资料进行单因素比较分析,进而采用Logistic回归进行多因素分析,比较两组之间的差异.结果 在单因素比较中,死亡组与好转组在下述指标之间差异有统计学意义(P＜0.05):一年内曾有过LRTI、一年内曾使用过有创呼吸机治疗、有哮喘家族史、外周血白细胞总数、中性粒细胞百分比、血红蛋白含量、动脉血二氧化碳分压(PaCO2)、动脉血酸碱度(pH值)、血清钠离子(Na+)、氯离子(Cl-)、谷草转氨酶(AST)、总蛋白、清蛋白、尿素氮(Bun)、肌酐(Cr)、痰培养致病性细菌阳性、大便潜血(OB)阳性.进一步多因素Logistic回归分析显示,患者一年内曾有过LRTI发作、一年内曾使用过有创呼吸机治疗、有哮喘家族史以及动脉血pH值降低、大便OB阳性等有统计学意义(P＜0.05).血清蛋白降低的统计学显示处于临界值(P=0.057).结论 一年内曾发生过LRTI、一年内曾使用有创呼吸机治疗、有哮喘家族史、入院时动脉血pH值降低和大便OB阳性等临床指标是呼吸内科住院LRTI患者死亡的独立危险因素,低清蛋白血症可能也会影响LRTI患者的预后.临床上应针对具有上述危险因素的患者给予更积极的治疗,以改善LRTI的预后.
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