Clinical characteristics and prognosis of patients with severe pneumonia infected by melioidosis

doi:10.3877/cma.j.issn.1674-6902.2025.02.016

Abstract

Abstract:

Objective

To analyze the clinical characteristics of patients with severe pneumonia infected by melioidosis and explore the related factors affecting the prognosis of patients.

Methods

From January 2020 to April 2024，49 patients with severe pneumonia infected by pseudomalleolus in the Second Naval Hospital of the Southern Theater Command，Sanya Central Hospital and Hainan Branch of the PLA General Hospital were selected as the research objects，and their general information，clinical symptoms，imaging manifestations and laboratory examination results were collected. According to the survival situation of patients with severe pneumonia infected by Bacteroides mallei one month after admission，28 survivors were the control group，and 21 deaths were the observation group. The clinical data of the two groups were compared，and the risk factors affecting the prognosis of patients with severe pneumonia infected by Bacteroides mallei were analyzed by multivariate Logistic regression.

Results

In the observation group，white blood cell count was（10.40±2.48） ×10⁹/L，lymphocyte count was （1.04±0.16）×10⁹/L，interleukin-6 was （64.75±9.20） ng/L and procalcitonin was （1.04±0.16） ng/L. The partial pressure of oxygen （PaO₂） was （47.18±6.94） mmHg，the partial pressure of carbon dioxide （PaCO₂） was （44.36±7.48） mmHg，the potassium level was （5.37±0.83）mmol/L. The proportion of patchy consolidation in main pathological types was 13 cases （61.90%） and the proportion of involvement of other organs or tissues was 12 cases（57.14%）. Compared with the observation group，in the control group，the age was （59.15±7.18） years，the white blood cell count was （8.71±2.39）×10⁹/L，the lymphocyte count was （1.16±0.20）×10⁹/L，the interleukin-6 level was （58.06±9.35） ng/L，and the procalcitonin level was （28.51±8.46） ng/L （assuming values were missing for procalcitonin range）. PaO₂ was （51.37±7.15） mmHg，PaCO₂ was （40.15±6.09） mmHg，the potassium level was （4.62±0.78） mmol/L.The proportion of patchy consolidation in main pathological types was 12 cases（41.38%） and the proportion of involvement of other organs or tissues was 8 cases （27.59%）（P ＜0.05）. Multivariate Logistic regression analysis showed that White blood cell count （OR=1.398，95%CI： 1.017～1.922），lymphocyte count （OR=0.607，95%CI： 0.426～0.864），creatinine （OR=1.548，95%CI：1.117 ～2.145），PaCO₂（OR=1.132，95%CI： 1.030～1.245） and large patular degeneration （OR=1.183，95%CI：1.020～1.372） were independent risk factors for the prognosis of patients with severe pneumonia infected with melioidosis （P＜0.05）.

Conclusion

White blood cell count，creatinine，PaCO₂，changes in lymphocyte count，large consolidation，pulmonary infiltration，nodules or cavities，and large plaque consolidation prognostic risk factors in patients with severe pneumonia infected by melioidosis.

Key words: Severe pneumonia, Melioidosis infection, Clinical features, Prognostic analysis, Risk factor

Dandan Zhu, Yun Yang, Zhong Hu, Mingli Han, Guangyan Peng, Zhao Hao. Clinical characteristics and prognosis of patients with severe pneumonia infected by melioidosis[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2025, 18(02): 289-294.

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Figures/Tables 3

临床资料	观察组（n=21）	对照组（n=28）	χ ² /t 值	P值
吸烟史［n（％）］	16（76.19）	19（67.86）	0.315	0.574
基础疾病［n（％）］
糖尿病	14（66.67）	14（50.00）	1.116	0.291
慢性阻塞性肺疾病	5（23.81）	6（21.43）	0.069	0.793
高血压	9（42.86）	10（35.71）	0.363	0.547
高脂血症	2（9.52）	1（3.57）	0.797	0.372
白细胞计数［×10⁹ / L，（ $\overset{ˉ}{x}$ ± s ）］	10.40±2.48	8.71±2.39	2.415	0.020
中性粒细胞比例［％，（ $\overset{ˉ}{x}$ ± s ）］	83.51±10.76	81.59±9.84	0.645	0.522
淋巴细胞计数［×10⁹ / L，（ $\overset{ˉ}{x}$ ± s ）］	1.04±0.16	1.16±0.20	2.354	0.023
白细胞介素-6［ng/ L，（ $\overset{ˉ}{x}$ ± s ）］	64.75±9.20	58.06±9.35	2.520	0.016
C 反应蛋白［mg/ L，（ $\overset{ˉ}{x}$ ± s ）］	167.84±29.87	160.41±23.54	0.947	0.350
降钙素原［ng/ L，（ $\overset{ˉ}{x}$ ± s ）］	33.66±7.49	28.51±8.46	2.272	0.028
ALT［IU/ L，（ $\overset{ˉ}{x}$ ± s ）］	81.45±12.93	78.38±10.57	0.893	0.378
肌酐［μmol，（ $\overset{ˉ}{x}$ ± s ）］	179.83±21.45	161.36±24.16	2.849	0.007
PaO₂［mmHg，（ $\overset{ˉ}{x}$ ± s ）］	47.18±6.94	51.37±7.15	2.080	0.043
PaCO₂［mmHg，（ $\overset{ˉ}{x}$ ± s ）］	44.36±7.48	40.15±6.09	2.120	0.041
钠［mmol/ L，（ $\overset{ˉ}{x}$ ± s ）］	118.49±15.37	124.05±14.21	1.303	0.200
钾［mmol/ L，（ $\overset{ˉ}{x}$ ± s ）］	5.37±0.83	4.62±0.78	3.234	0.002
钙［mmol/ L，（ $\overset{ˉ}{x}$ ± s ）］	1.12±0.33	1.20±0.27	0.912	0.368
凝血酶原时间［s，（ $\overset{ˉ}{x}$ ± s ）］	17.32±3.06	16.15±2.97	1.351	0.184
活化部分凝血活酶时间［s，（ $\overset{ˉ}{x}$ ± s ）］	62.48±8.12	59.83±9.72	1.048	0.300

临床资料	观察组（n=21）	对照组（n=28）	χ ² /t 值	P值
吸烟史［n（％）］	16（76.19）	19（67.86）	0.315	0.574
基础疾病［n（％）］
糖尿病	14（66.67）	14（50.00）	1.116	0.291
慢性阻塞性肺疾病	5（23.81）	6（21.43）	0.069	0.793
高血压	9（42.86）	10（35.71）	0.363	0.547
高脂血症	2（9.52）	1（3.57）	0.797	0.372
白细胞计数［×10⁹ / L，（ $\overset{ˉ}{x}$ ± s ）］	10.40±2.48	8.71±2.39	2.415	0.020
中性粒细胞比例［％，（ $\overset{ˉ}{x}$ ± s ）］	83.51±10.76	81.59±9.84	0.645	0.522
淋巴细胞计数［×10⁹ / L，（ $\overset{ˉ}{x}$ ± s ）］	1.04±0.16	1.16±0.20	2.354	0.023
白细胞介素-6［ng/ L，（ $\overset{ˉ}{x}$ ± s ）］	64.75±9.20	58.06±9.35	2.520	0.016
C 反应蛋白［mg/ L，（ $\overset{ˉ}{x}$ ± s ）］	167.84±29.87	160.41±23.54	0.947	0.350
降钙素原［ng/ L，（ $\overset{ˉ}{x}$ ± s ）］	33.66±7.49	28.51±8.46	2.272	0.028
ALT［IU/ L，（ $\overset{ˉ}{x}$ ± s ）］	81.45±12.93	78.38±10.57	0.893	0.378
肌酐［μmol，（ $\overset{ˉ}{x}$ ± s ）］	179.83±21.45	161.36±24.16	2.849	0.007
PaO₂［mmHg，（ $\overset{ˉ}{x}$ ± s ）］	47.18±6.94	51.37±7.15	2.080	0.043
PaCO₂［mmHg，（ $\overset{ˉ}{x}$ ± s ）］	44.36±7.48	40.15±6.09	2.120	0.041
钠［mmol/ L，（ $\overset{ˉ}{x}$ ± s ）］	118.49±15.37	124.05±14.21	1.303	0.200
钾［mmol/ L，（ $\overset{ˉ}{x}$ ± s ）］	5.37±0.83	4.62±0.78	3.234	0.002
钙［mmol/ L，（ $\overset{ˉ}{x}$ ± s ）］	1.12±0.33	1.20±0.27	0.912	0.368
凝血酶原时间［s，（ $\overset{ˉ}{x}$ ± s ）］	17.32±3.06	16.15±2.97	1.351	0.184
活化部分凝血活酶时间［s，（ $\overset{ˉ}{x}$ ± s ）］	62.48±8.12	59.83±9.72	1.048	0.300

影像学特征	观察组（n=21）	对照组（n=28）	χ ²	P值
受累肺叶数			0.012	0.913
单	3（14.29）	5（17.86）
多	18（85.71）	23（82.14）
主要病理形态			2.063	0.007
结节	5（23.81）	11（39.29）
斑片状毛玻璃样变	3（14.29）	6（20.69）
大斑片状实变	13（61.90）	11（39.29）
肺不张	4（19.05）	9（32.14）	0.910	0.340
支气管征	13（61.90）	16（57.14）	0.227	0.634
肺门征	14（66.67）	13（46.43）	2.339	0.126
空洞	7（33.33）	6（21.43）	1.012	0.314
气液平面	0（0.00）	1（3.57）	0.027	0.870
胸腔积液	10（47.62）	9（32.14）	1.422	0.233
胸腔增厚和黏连	6（28.57）	11（39.29）	0.476	0.490
纵膈淋巴结肿大	3（14.29）	5（17.86）	0.012	0.913
其他器官或组织受累	12（57.14）	8（28.57）	4.434	0.035

影响因素	β	标准误差	Wald	P值	OR	95％CI
影响因素	β	标准误差	Wald	P值	OR	下限	上限
白细胞计数	0.335	0.162	4.253	0.039	1.398	1.017	1.922
淋巴细胞计数	-0.499	0.180	7.669	0.006	0.607	0.426	0.864
白细胞介素-6	0.037	0.039	0.902	0.342	1.038	0.961	1.120
降钙素原	0.052	0.042	1.538	0.215	1.053	0.970	1.143
肌酐	0.437	0.167	6.883	0.009	1.548	1.117	2.145
PaO₂	-0.081	0.053	2.372	0.124	0.922	0.831	1.022
PaCO₂	0.124	0.048	6.610	0.010	1.132	1.030	1.245
钾	0.547	0.383	2.033	0.154	1.727	0.815	3.661
大斑片状实变	0.168	0.076	4.911	0.027	1.183	1.020	1.372
其他器官或组织受累	0.982	0.713	1.899	0.168	2.670	0.660	10.797

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