Characteristics and prognosis of pulmonary infection in patients with neurologic disease and hypoproteinemia

Abstract

Objective: To examine the characteristics and the prognostic influence of pulmonary infections in neurologic disease patients with mild-to-severe hypoproteinemia. Methods: We used a retrospective survey method to analyze the characteristics and prognoses of 220 patients with hypoproteinemia complicated with pulmonary infection in the Internal Medicine-Neurology Intensive Care Unit at the First Affiliated Hospital of Chongqing Medical University from January 2010 to December 2013. The patients were divided into mild, moderate and severe hypoproteinemia groups according to their serum albumin levels. The analysis included patient age, sex, acute physiology and chronic health evaluation (APACHE II score), and characteristics of the pulmonary infection, nutritional support and prognosis, among others. Results: Differences in the general information of the 220 cases of hypoalbuminemia patients complicated with varying degrees of pulmonary infection (APACHE II score, age, disease distribution) were statistically significant. The pulmonary infection onset time and pathogen susceptibility in the patients with mild-to-severe hypoalbuminemia were not significantly different. Pulmonary infection onset was more frequently observed within the first 3–11 days following admission in all groups. The nutritional support method did not significantly influence serum albumin protein levels. However, the neurological intensive care unit stay length, total hospitalization cost and disease distribution were significantly different among the patient groups. Conclusions: Patients with cerebrovascular disease, intracranial infections and epilepsy complicated with pulmonary infection represent the high-risk groups for hypoalbuminemia. The Acinetobacter baumannii complex represents the main group of pathogenic bacteria causing lung infections, and the high-risk period for lung infections is 3–11 days after the occurrence of hypoalbuminemia. Patients with severe hypoalbuminemia complicated with pulmonary infection have the worst prognoses.

Keywords:

• hypoproteinemia
• neurologic disease
• nutritional support
• prognosis
• pulmonary infection

Financial & competing interests disclosure

This work was supported by the National Clinical Key Specialty Construction Foundation of China. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Key issues

• In addition to paying close attention to the treatment and care of the primary disease, by studying the characteristics of pulmonary infections and their influence on the overall prognosis of patients with neurologic disease and hypoalbuminemia, we can provide clinical evidence for the treatment and prevention of complications.

• Specially assigned personnel performed the retrospective analysis of the medical records of the 220 eligible patients. Statistical analyses included age, sex, acute physiology and chronic health evaluation (APACHE II score), lung infection characteristics, nutritional support methods, prognosis and serum albumin levels.

• The Acinetobacter baumannii complex represents the main group of pathogenic bacteria causing lung infections, and the high-risk period for lung infections is 3–11 days after the occurrence of hypoalbuminemia.

• Nutritional support had little effect on the protein levels of hypoproteinemic patients with pulmonary infections, suggesting that patients’ individual needs must be considered when implementing nutritional assessment.

• Serum albumin levels can be used as an index to assess the illness severity and the prognosis of hypoalbuminemic patients with pulmonary infections.

• As protein levels decreased, older patients with higher APACHE II scores had poorer prognoses and increased mortality rates.

• Cerebrovascular disease, intracranial infections and epilepsy patients with hypoalbuminemia complicated with pulmonary infection represent the high-risk groups.

• Hypoproteinemia complicated with pulmonary infection affects disease outcomes, increases mortality and prolongs the recovery time.

• Patients with severe hypoalbuminemia complicated with pulmonary infection have the worst prognosis. In NICUs, the timely detection of pulmonary infections and the pathogen distribution is required.