Luận án nghiên cứu đặc điểm lâm sàng, cận lâm sàng, vi khuẩn gây bệnh và biến đổi cytokine huyết thanh ở bệnh nhân viêm phổi cộng đồng nhập viện tại hải phòng tt

MINISTRY OF EDUCATION

MINISTRY OF NATIONAL

AND TRAINING

DEFENSE

MILITARY MEDICAL UNIVERSITY

LE THI DIEU HIEN

STUDY ON CLINICAL, SUBCLINICAL
CHARACTERISTICS, BACTERIAL PATHOGEN,
SERUM CYTOKINE IN COMMUNITY ACQUIRED
PNEUMONIA PATIENTS ADMITTED AT
HOSPITAL IN HAI PHONG
Specialization: Internal medicine
Number : 9720107

SUMMARY OF DOCTOR THESIS

HA NOI - 2022


RESEARCH WAS COMPLETED IN MILITARY MEDICAL
UNIVERSITY
Academic supervisor:
1. Assoc. Prof. TA BA THANG, MD, PhD
2. Assoc. Prof. MAI XUAN KHAN

Reviewer 1: Assoc. Prof. Phan Thu Phương, MD, PhD
Reviewer 2: Assoc. Prof. Phạm Quốc Hoàn, MD, PhD
Reviewer 3: Assoc. Prof. Nguyễn Viết Nhung, MD, PhD

The thesis will defend the Committee of Military Medical
University
Time :

Hour

date month

year

Location for search the thesis:
1.

National Library

2.

Military Medical University Library

3.

………………………….


1
INTRODUCTION

Community-acquired pneumonia (CAP) is one of the lower
respiratory tract infections with high morbidity and mortality
worldwide, especially in the elderly and with chronic comorbidities.
Currently, the common cause of CAP is still caused by bacteria, in
which the leading cause is caused by typical bacteria (S. pneumoniae
and H. Influenzae). However, there are changes in the distribution of
bacteria as well as antibiotic susceptibility according to geography,
the degree of pneumonia as well as the patient's location. Viet TiepHai Phong Hospital is the central general hospital of the province
and the last line of the northern coastal provinces. There have been
some studies on clinical, subclinical and etiology of CAP at some
hospitals in Hai Phong, but there has not been any in-depth research
on CAP caused by bacteria. Cytokines such as Tumor necrosis
factor-α (TNF-α), Interleukine-6 (IL-6), Interleukine-10 (IL-10) play
a major role in the inflammatory mechanism in CAP. Changes in
these cytokines are associated with the severity of pneumonia as well
as treatment outcomes. However, the results on the changes of serum
cytokines are still different in the studies, and there are no specific
results on their changes in the group of patients with bacterial CAP.
For this reason, we carried out the study "Study on clinical,
subclinical characteristics, bacterial pathogen and serum
cytokine in community acquired pneumonia patients admitted at
hospital in Hai Phong". This study aimed including:
1. Clinical, subclinical characteristics and antibiotic
resistance of bacteria in CAP patients at hospital in Hai Phong.
2. Evaluation of changes of levels TNF-α, IL-6, and IL-10 in
serum and the relationship with clinical and subclinical
characteristics in CAP patients at hospital in Hai Phong.
2. The summary of new main scientific contribution of the thesis
The research results of the thesis have some contributions to the
respiratory specialty as follows:

- Characteristics of patients with community-acquired bacterial
pneumonia hospitalized at Viet Tiep Friendship Hospital - Hai


2
Phong: the age group ≥60 mainly encountered (74.3%); The
proportion of male patients is higher than female. The rate of comorbidities is high (60.2%). The severity of the disease was found in
44.8%. On chest X-ray, diffuse lesions accounted for the majority
(82.0%). The result of sputum culture was that Gram-negative
bacteria accounted for the majority (84.6%), of which K.pneumoniae
30.7%, P.aeruginosa 24.3%. The percentage of Gram-positive
bacteria was 15.4%. The rate of antibiotic-sensitive bacteria was
57.6%, antibiotic resistance 42.3% (resistance to 1 antibiotic was
7.6%, resistance to multiple antibiotics was 34.5%).
- Serum levels of TNF-α, IL-6 and IL-10 at the time of admission
were all higher than those of healthy subjects. Serum IL-6
concentration on day 7 after treatment decreased significantly
compared to the time of admission. Increased levels of cytokines
TNF-α, IL-6 were correlated with the average lesion area on chest Xray. In the group of patients who isolated Gram-positive bacteria, the
average serum IL-10 concentration on day 1 was higher than that in
the group of patients who isolated Gram-negative bacteria (p<0.05).
The percentage of patients with increased serum IL-6 levels on day 1
in the group of patients with good progress was higher than in the
group of patients with severe progression (p<0.05).
The research results contribute to improving the efficiency of
diagnosis, treatment and prognosis of CAP caused by hospitalized
bacteria.
3. The structure of the thesis
The major of the thesis was 143 pages: Introduction (2
pages), Overview (43 pages), Subjects and methods (23 pages),

Results (42 pages), Discussion (30 pages), Conclusion (2 pages),
Recommendations (1 pages). This thesis was 34 tables, 10 figures,
and 155 references (30 Vietnamese references, 121 English
references; 58 references within last 5 years) and Appendix list of
research subjects and medical records.


3
Chapter 1: OVERVIEW
1.1. COMMUNITY – ACQUIRED PNEUMONIA
1.1.1. Definition of community – acquired pneumonia
1.1.2. Epidemiology of community – acquired pneumonia
1.1.3. Pathogenesis of community – acquired pneumonia
1.1.4. Symptoms of community – acquired pneumonia
1.1.5. Subclinical symptoms of community – acquired pneumonia
1.1.6. Diagnosis of community – acquired pneumonia
1.2. ETOLOGY BACTERIA AND CHARECTERICS OF
ANTIBIOTIC RESISTANCE OF BACTERIA CAUSING
COMMUNITY – ACQUIRED PNEUMONIA
1.2.1. Bacterial causes of community-acquired pneumonia
- Streptococcus pneumoniae
- Haemophilus Influenza
- Klebsiella pneumoniae
- Staphylococcus aureus
- Acinotebacter baumannii
- Pseudomonas aeruginosa
- Atypical bacteria
1.2.2. Bacterial detection methods
1.2.3. Antibiotic resistance of bacteria causing communityacquired pneumonia
1.3. ROLES OF CYTOKINE IN COMMUNITY-ACQUIRED

PNEUMONIA
1.3.1. The concept, role, and origin of cytokines
1.3.2. Origin of TNF-Alpha, IL-6, and IL-10
1.3.2.1. TNF- α (Tumour Necrosis Factor- Alpha)
1.3.2.2. Interleukine-6 (IL-6)
1.3.2.3. Interleukine-10 (IL-10)
1.3.3. Cytokine test method
1.4. RESEARCH RELATED TO THIS RESEARCH THEME


4
1.4.1. Research on clinical, bacteriological characteristics and
prognosis of community-acquired pneumonia
1.4.2. Research on changes of levels of cytokine in serum
Chapter 2: RESEARCH SUBJECTS AND METHODS
2.1. RESEARCH SUBJECTS
- Disease group: 78 adult patients with community-acquired
bacterial pneumonia, hospitalized for inpatient treatment at Viet Tiep
general Hospital - Hai Phong, from January 2017 to December 2019.
- Control group: 34 people who came hospital for health check-up at
the medical examination department of Hai Phong Medical
University Hospital from January 2017 to December 2019. The
people in control group were tested levels of cytokines in serum as a
value for comparing to disease group.
2.1.1. Subjects
2.1.1.1. Selection criteria for disease group
- The patient was diagnosed with CAP according to the diagnostic
criteria of the American Thoracic Society 2001 [27] and updated
version 2014 [28]:
+ The symptoms of lower respiratory infection: cough, sputum,

sputum with dark color, shortness of breath, with or without fever.
+ Hear crackles in the lungs
+ Chest X-ray showed infiltrates.
- Patients with results of sputum quantitative bacterial culture
- 16 years old or older
- Agree for participating this research.
2.1.1.2. Selection criteria for control group
- People who were healthy in the past and present, and they did not
have immunodeficiency diseases, cancer, autoimmune diseases,
chronic diseases, and infections.
- Agree for participating this research
2.1.2. Exclusion criteria


5
2.1.2.1. Disease group
- The patients who have another co-morbidity regarding respiratory
disease such as tuberculosis, bronchiectasis, chronic obstructive
pulmonary disease (COPD).
- With diseases such as cancer, autoimmune diseases, other
infections.
- Using corticosteroid for treatment within one month.
2.1.2.2. Control group
- With an acute infection within one month.
- Did not agree to participate in the research.
2.2. RESEARCH CONTENTS
2.2.1. Clinical, paraclinical characteristics and antibiotic
resistance in patients with community-acquired bacterial
pneumonia
- Clinical: general characteristics of the patients, functional

symptoms, physical symptoms, complications, disease severity,
treatment results.
- Subclinical: results of blood tests, blood biochemistry, chest X-ray,
inflammatory markers (CRP and PCT).
- Results of sputum quantitative bacterial culture and antibiotic
resistance of pathogenic bacteria.
2.2.2. Evaluation of changes of levels TNF-α, IL-6, and IL-10 in
serum and their relationship with clinical and paraclinical
charecteriistics.
- Valuate the changes of TNF-α, IL-6, IL-10 in serum and each type
of cytokine among the disease group compared with the control
group.
- Assess the relationship between cytokines with fever symptoms,
age group, severity of disease, complications, treatment results.
- Evaluate the relationship between cytokines with amount of white
blood cells (WBCs), chest X-ray, results of bacterial isolation.
2.3. METHODS 


6
2.3.1. Study design
Cross-sectional study, longitudinal follow-up study
2.3.2. Study location and period
The study was conducted at the department of respiratory
medicine - Viet Tiep general Hospital, Hai Phong and the department
of medical examination - Hai Phong Medical University Hospital,
from January 2017 to December 2019.
2.3.3. Sample size
Sample size: we selected a convenient sample. Subjects was
adult patients diagnosed with CAP, hospitalized for inpatient

treatment at Viet Tiep general Hospital - Hai Phong, from January
2017 to December 2019
Sampling method: The subjects was collected by a
convenient method. After the patient is admitted to the hospital, they
were asked participation this research and they was accumulating
during the research period. The patients who met the research
eligibility in both inclusion criteria and exclusion criteria such as
with diagnosed CAP and hospitalized for treatment at the
Respiratory Department - Viet Tiep general Hospital, Hai Phong
were selected in the sample.
During the study period from 1/2017 to 12/2019, we
collected 215 patients with CAP, in which 78 patients met the
research criteria for analysis (with isolated bacteria in phlegm
specimens).
2.3.4. Research methods
2.3.5. Methods of evaluating results
2.4. Analysis statistics
2.4.1. Statistical analysis
- The collected data was entered using EXCEL 2010 software and
analyzed by STATA 14.2 software.
2.4.2. Error control methods
2.5. ETHNIC CONSIDERRATION


7
Chapter 3: RESEARCH RESULTS
3.1. CLINICAL, SUBCLINICAL CHARATERISTICS AND
ANTIBIOTIC RESISTANCE OF BACTERIA IN CAP
PATIENTS AT HOSPITAL
3.1.1. Characteristics of patients

Table 3.1. Age and gender characteristics of patients
Men
Women
Total
Age groups
n
%
n
%
n
%
<30
0
1
3.7
1
1.3
30-39
2
3.9
0
2
2.6
40 – 49
4
7.8
0
4
5.1
50 – 59

8
15.7
5
18.5
13
16.7
60 – 69
15
29.4
6
22.2
21
26.9
70- 79
13
25.5
5
18.5
18
23.1
80-89
9
17.7
10
37.1
19
24.3
Total
51
100.0

27
100.0
78
100.0
X ±SD
66.4±13.7
70.8±15.6
68.9±14.5
34-91
19-93
19-93
(min – max)
This result showed that men were 51(65.4%) and women
were 27(34.6%) with the mean aged of 68.9±14.5.
3.1.2. Clinical characteristics of patients
Table 3.4. Physical symptoms of patients
Physical symptoms
n= 78
%
Dry cough
5
6.4
Transparent
22
28.2
Sputum
Dark
42
53.8
Rusty

4
5.1
Hemoptysis
6
7.6
Chest pain
77
98.7
Dyspnea
60
76.2
This study showed that the subject symptoms was reported
the most common with sputum dark (53.8%); chest pain (98.7%) and
dyspnea (76.2%).


8
Table 3.5. Systemic symptoms of study subjects
Symptoms
n=78
%
Temperature
( oC)

Pulse rate
( l/p)
Sytolic blood
pressrure
( mmHg)
Confusion

X ± SD

Normal
Decrease
Increase

X ± SD

Normal
Increase
Decrease

X ± SD

Normal
Increase
Decrease
Yes

37.34±0.76
45
32
1

57.6
41.0
1.3
91.46±13.5

49
62.8
29
37.1
0
126.28±15.8
57
73.0
19
24.3
2
2.6
2
2.6

This result showed that the temperarute was 33 (42.3%). in which it
was 41.0% patients with decrease fever and 1.3% patients with
increase fever.
Table 3.6. Respiratory physical symptoms of the study subjects
Symptoms
n= 78
%
Normal
16
20.5
Increase
62
79.4
Respiration rate
X ± SD

25.3±5.0
Consolidated syndrome
69
88.4
Bronchial syndrome
69
88.4
Pleural effusion
16
20.5
This results repored that mean of respiration rate was
25.3±5.0. consolidated syndrome and bronchial syndrome were 69
(88.4%) patients in each syndrome.


9

Figure 3.2. Complications of patients
The figure indicated that pleural effusion was 10.3% and
acute respiratory distress syndrome was 6.4%.

Figure 3.3. Severity score according to CURB-65
This figure showed the patients with CURB-65 < 2 were
43(55.12%). and the patients with CURB-65 ≥ 2 were 44.88%.


10
3.1.3. Subclinical characteristics of paitients
Table 3.9. Blood biochemical and inflammatory markers
Index

n= 78
%
Normal
62
79.4
Ure
16
20.5
Increase
( mmol/L)
X ±SD
6.89±3.41
Normal
0
CRP
78
100.0
Increase
(mg/L)
X ±SD
163.91±98.47
Normal
0
PCT
78
100.0
Increase
(pmol/L)
X ±SD
6.19±4.32

This result reported that 16 (20.5%) patients with high level of ure in
blood. There were 100% patients with high levels of CRP và PCT.
Table 3.11. Characteristic of chest X-ray
Chest X-ray results
n= 78
Left lung
25
Injury
Right lung
43
location
Both
10
Nodule
5
Clouds
53
Round shading
3
Blurred band
2
Morphology
Cavity
1
Combination lesions
1
Pleural effusion
13
Pneumothorax
0

Local
14
Distribution
Diffuse
64
Large
12
Locate
Moderate
40
injury
Small
26

%
32.0
55.1
12.8
6.4
69.9
3.8
2.6
1.3
1.3
16.6
17.9
82.0
15.3
51.2
33.3

11
This result showed that the damage in chest X-ray in the right lung
was most common with 43(55.1%). and the damage in chest X-ray in
both was 12.8%.
3.1.4. Characteristics of bacteria
Table 3.13. Results of sputum bacterial culture
Bacteria
n= 78
%
Staphylococcus aureus
6
7.7
Gram
Streptococcus pneumoniae
4
5.1
-positive
Staphylococcus haemolyticus
1
1.3
bacteria
Streptococcus anginosus
1
1.3
Total
12
15.4
Klebsiella pneumoniae

24
30.7
Pseudomonas aeruginosa
19
24.4
Acinetobacter Baumannii
11
14.1
Gram
- Stenotrophomonas
5
6.4
negative maltophilia
bacteria
Escherichia coli
4
5.1
Enterobacter spp
1
1.3
Proteus
1
1.3
Aeromonas sp
1
1.3
Total
66
84.6
Sputum culture results showed that Gram-negative bacteria

accounted for the majority (84.6%) and Gram-positive bacteria
accounted for 15.4%.


12

Figure 3.6. The result of antibiogram of Klebsiella pneumoniae
Klebsiella pneumoniae indicated a resistant to most cephalosporins.
The carbapenem group was also resistant up to 1/24 (4.1%).

Figure 3.7. The result of antibiogram of Acinetobacter baumannii
The percentage of resistance of Acinetobacter baumannii
bacteria was high with the Cephalosporin group.


13

Figure 3.10. The results of antibiogram of Streptococcus pneumonia
The result showed that the Streptocosus pneumonia has a high
susceptibility to antibiotics.
3.2. EVALUATION OF CHANGES OF LEVELS TNF-α. IL-6.
and IL-10 IN SERUM AND RELATIONSHIP WITH
CLINICAL AND SUBCLINICAL CHARACTERISTICS IN
CAP PATIENTS AT HOSPITAL IN HAI PHONG
3.2.1. The changes of levels of cytokine in serum
Table 3.16. Changes in mean levels of serum cytokines
Cytokin

Control

Median
(p25-p75)

n=34 (1)

Patient
Day 1

Day 7

n=78 (2)

n=78 (3)

p

TNF-α

0.35

0.76

1.01

p1.2=0.020*

(pg/mL)

0.18-1.00

0.43-1.42

0.55-2.37

p2.3=0.107**

1.11

2.15

1.12

p1.2=0.022*

0.79-1.92

0.79-6.98

0.70-2.66

p2.3=0.003**

1.09

1.18

1.11

p1.2=0.349*

0.65-1.63

0.45-2.58

0.74-1.91

p2.3=0.084**

IL- 6
(pg/mL)
IL- 10
(pg/mL)

* Mann Whitney test

** Wilcoxon signrank test

The mean serum TNF-α levels on days 1 and 7 were higher than that
of healthy subject, but there was no difference between days 1 and 7.
3.2.2. Relationship between levels of cytokine with symptoms
Table 3.22. Relationship between average cytokine levels on day 1
Cytokin
TNF-α
(pg/

Normal
High

with severity score
CURB-65 <2 CURB-65 ≥2

n=43
%
n=35
%
11
68.75
5
31.25
32
51.61
30
48.39

p
0.219*


14
Median
0.71
0.81
0.245**
(p25-p75)
0.25-1.29
0.53-1.45
ml)
Normal
15
57.69
11

42.31
0.747*
IL-6
High
28
53.85
24
46.15
(pg/
Median
1.89
2.55
ml)
0.912**
(p25-p75)
0.76-14.79
0.96-5.43
Normal
20
57.14
15
42.86
0.747*
IL-10
High
23
53.49
20
46.51
(pg/

Median
1.15
1.58
ml)
0.310**
(p25-p75)
0.41-1.99
0.51-3.22
* Chi-Square test
** Wilcoxon rank-sum test
The result showed that there was no significant between levels of
TNF-α, IL-6 và IL-10 and the median CURB-65 score (p>0.05).
3.2.3. Relationship between levels of cytokin with subclinical
characteristics
Bảng 3.26. The relationship between levels of cytokine at the 1 day
and chest X-ray
Cytokin
Normal
TNF-α
(pg/
ml)

IL-6
(pg/
ml)
IL-10
(pg/

Increase

Lesion of chest X-ray
Large
Moderate
Small
n
%
n
%
n
%
12.
30.7
3
25.0
5
8
5
7
87.
69.2
9
75
35
18
5
3

Median
(p25p75)

0.68
0.38-10.92

0.77
0.55-1.56

Normal

5

41.67

9

Increase

7

58.33

31

Median
(p25p75)
Normal

22.
5
77.
5

2.8
0.55-14.57

3.93
1.19-7.83

5

20

41.67

50

0.71
0.24-1.35
12
14

46.1
5
53.8
5

1.22
0.7-2.31
10

38.4

6

p

0.183*
0.557*
*
0.110*
0.053*
*
0.635*


15

ml)

Increase

7

Median
(p25p75)

1.43
0.54-2.28

* Chi-Square test

58.33

20

50

1.10
0.34-2.47

16

61.5
4

1.37
0.87-3.22

0.633*
*

**Kruskal-Wallis test

In the group of patients with moderate lung lesions on X-ray, the
median levels of TNF-α, IL-6 was higher than that of patients with
large and small lung lesion, but the result did not show significantly
(p>0.05).
3.2.4. Multivariate logistic regression analysis on high cytokin
status analysis and factors of history, pathological symptom and
lesions on X-ray
Bảng 3.30. Multiple logistic regression analysis on gender, sputum,
Chest X-ray, blood test. and TNF-α

Increase levels of TNF- α
Variables
OR
p
95%CI
Gender (men=0. women=1)
2.18 0.234
0.6-7.91
Sputum (yes=1; no=0)
3.34 0.315 0.317-35.29
Pleural effusion (yes=1. no=0)
4.35 0.072
0.88-21.65
CRP (mg/L)
1.01 0.028
1.0-1.01
Ure (mmol/L)
0.88 0.235
0.72-1.09
Small
Locate injury
Moderate
6.3
0.021
1.31-30.24
Large
2.79 0.285
0.42-18.29
Model
R2=0.19 ; p=0.035

There was relationship between high TNF-α with levels of
CRP (OR=1.01; p<0.05).


16
Bảng 3.31. Multivariate logistic regression analysis on gender.
Sputum, Chest X-ray, blood test, and high IL-6
Increase levels of IL-6
Variable
OR
p
95%CI
Gender (men=0. women=1)
0.55
0.27
0.18-1.61
Sputum (yes=1; no=0)
0.48
0.31
0.11-2.04
Pleural effusion (yes=1. no=0)
1.76
0.41
0.46-6.78
CRP (mg/L)
0.99
0.59
0.99-1.0
Ure (mmol/L)
1.03

0.67
0.89-1.19
Small
Locate injury
Moderate
3.32
0.03
1.06-10.35
Large
2.03 0.334
0.48-8.63
Model
R2=0.08 ; p=0.344
There was relationship between high IL-6 with zone of lesions on
chest X-ray (OR=3.32; p>0.05).
Bảng 3.32. Multivariate logistic regression analysis on gender.
Sputum, Chest X-ray, blood test, and high IL-10
Increase levels of IL-10
Variable
OR
p
95%CI
Gender (men=0. women=1)
1.07 0.89
0.41-2.79
Sputum (yes=1; no=0)
0.27 0.08
0.06-1.2
Pleural effusion (yes=1. no=0)
0.9

0.87
0.26-3.18
CRP (mg/L)
1.0
0.62
0.99-1.0
Ure (mmol/L)
0.99 0.93
0.86-1.14
Small
Zone of injury
Moderate
0.59 0.33
0.21-1.71
Large
0.57 0.44
0.14-2.35
Model
R2=0.04 ; p=0.725
There was not relationship between high IL-10 with gender,
Sputum, pleural effusion, zone of lesions on the chest X-ray, levels
of Ure and CRP (p>0.05).


17
Chapter 4
DISCUSSION
4.1. CLINICAL. SUBCLINICAL CHARATERISTICS AND
ANTIBIOTIC RESISTANCE OF BACTERIA IN CAP
PATIENTS AT HOSPITAL

4.1.1. Characteristics of patients
- Characteristics of the age and gender of patients were reported in
this study. The results showed that the total subjects were 78
patients, in which 51 men accounted for 65.3% and 27 women
accounted for 34.6% (Table 3.1). The mean age of the patients was
68.9±14.5. Thus, most of the patients were older adults in our study.
The age of the patients in our study was consistent with the previous
study regarding the risk of CAP in the world. Recent research results
have shown that the percentage of older adults with CAP was
increased. and this issue needs attention in the community. Similarly,
Kensuke (2013) reported that the prevalence of CAP in the elderly ≥
65 years old was 4.6/1.000 people/year (95% CI: 3.8- 5.5), which
was ten times higher than the prevalence in the younger age group.
4.1.2. Clinical characteristics of patients
- The results of respiratory symptoms with a high rate were shown in
table 3.4. The results indicated that dry cough accounted for 93.5%.
chest pain accounted for 98.7% and dyspnea accounted for 76.2%.
The symptoms were less common hemoptysis accounted for 7.7%.
The symptoms were various and the most common were cough and
chest pain. which were consistent with the literature studies in the
world on the subjective symptoms of VAP. Similarly. Nguyen Van
Thanh has conducted a study on CAP in Can Tho, the study reported
that common symptoms with cough (88.1%), fever (85.7%). and
dyspnea 56.5%.
- On examination, the patient experienced infectious syndrome and
acute respiratory distress syndrome. Fever were 33 patients,


18
accounting for 42.3%. in which mild fever accounted for 41.03% and

high fever accounted for 1.28%. The average temperature is
37.34±0.760C. There were 2 patients with consciousness disorder.
accounting for 2.6%. In 78 patients, 62(79.5%) increased respiratory
rate. that average respiratory rate was 25.37±5.08 rate/min. The rate
of patients with complications in our study was less common. The
most complication was pleural effusion syndrome. This result is
similar to the report of Patrick G. P. Charles. who summarized that
pleural effusion is a common complication of CAP.
Our study utilized the CURB-65 index. which was cut-point
2 dividings < 2 and ≥ 2 points. As a result, the proportion of patients
with moderate disease (< 2 points) was 55.1% and 44.9% patients.
who were at ≥ 2 points. The results of our study are different from
the study of Trinh Hieu Trinh, he indicated that was 9.2% of patients
with severe severity, 23% of patients with moderate severity, and
64.1% of patients with mild severity. This difference may be due to
the number of subjects in the author's study of 649 patients from
more than 10 hospitals.
4.1.3. Subclinical characteristics of paitients
- Blood biochemical characteristics indicated that the results
of inflammatory factors are shown in table 3.9 in the study. The
average CRP concentration was 163.9±98.4mg/l and the PCT
concentration was 6.19± 4.3ng/ml, these average concentrations were
high. Similarly. Elena Prina indicated that the CRP and PCT provide
reliable information on the degree of inflammation, severity and the
author recommended prescribing antibiotics for treatment with CRP
concentrations 20mg/l and PCT>0.5ng/ml at risk 0.78 (95% CI:
0.66-0.92). Blood biochemical indexes such as urea and creatinine in
our results were normal. This result is similar to Patrick's study
showing that blood urea increased over 7 mmol/L accounted for
43.1%.