摘要
目的比较社区获得性肺炎(CAP)患者入院时的急性生理学和慢性健康状况评分系统Ⅱ(APACHEⅡ)、肺炎严重指数(PSI)、CURB-65评分及血清降钙素原(PCT)在预测临床转归中的价值并探讨预后的影响因素。方法回顾性分析2015年1月至2016年12月山西医科大学第一医院呼吸与危重症医学科收治的CAP患者的临床资料,记录患者入院24 h内的APACHEⅡ评分、PSI评分、CURB-65评分和血清PCT水平。以此次住院的临床结局(痊愈或好转,恶化或死亡)作为研究终点,分别利用受试者工作特征(ROC)曲线及二分类Logistic回归评价相关指标对预后的判定能力并确定界值;筛选CAP患者病情恶化及死亡的高危因素。结果共纳入CAP患者235例,其中男146例,女89例,平均年龄(60.4±18.1)岁。全部患者分为2组:好转痊愈组205例,恶化死亡组30例。ROC曲线结果显示,预测CAP患者病情恶化及死亡风险的ROC曲线下面积从大到小依次为APACHEⅡ评分(0.889)、PSI评分(0.850)、CURB-65评分(0.789)和血清PCT(0.720)。当APACHEⅡ评分和PSI评分分别以≥11分和≥91分为截点时预测性能最佳。Logistic回归分析结果显示,APACHEⅡ评分和PCT是CAP患者病情恶化死亡的独立危险因素。结论在预测CAP患者病情及临床转归的4项指标中,预测效能从高到低依次为APACHEⅡ评分>PSI评分>CURB-65评分>PCT。其中,APACHEⅡ评分和PCT是CAP患者病情恶化死亡的独立危险因素。但单次血清PCT水平预测能力有限,联合APACHEⅡ评分及PCT可以提高预测的特异度,但会降低灵敏度。
Objective To compare the value of the acute physiology and chronic health evaluation Ⅱ（APACHE Ⅱ） scores, the pneumonia severity index （PSI） scores）, the CURB-65 scores, and serum procalcitonin （PCT） concentration in prediction of prognosis for inpatients with community-acquired pneumonia （CAP） and discuss the influence factors. Methods Retrospective analysis was conducted based on the APACHE Ⅱscores, the CURB-65 scores, the PSI scores and PCT concentration of hospitalized CAP patients admitted in the Department of Respiratory Medicine of First Hospital of Shanxi Medical University between January 2015 and December 2016, and within 24 hours of their admission. The end point of this study was the clinical outcome of hospitalization （recovery, improvement, exacerbation or death）. Receiver operating characteristic （ROC） curve analysis and binary logistic regression models were used to assess the ability of prognostic evaluation and determine the boundary value, to screen risk factors that influence deterioration and death in CAP patients. Results Two hundred and thirty-five CAP patients were enrolled with 146 males and 89 females at an average age of （60.4_＋ 18.1） years old. All patients were divided into 2 groups： improving recovery group had 205 cases, and deteriorating group had 30 cases. The rank of areas under the ROC curve for predicting the deterioration and death risk of CAP, from big to small were APACHE Ⅱ （0.889）, PSI （0.850）, CURB-65 （0.789）, and PCT （0.720）.APACHE Ⅱ score over Ⅱpoints and PSI score over 91 points were optimal cut-offvalues for the prognostic assessment. Moreover, the logistic regression analysis revealed that APACHE Ⅱ score and PCT were independent risk factors of deterioration and death in CAP patients. Conclusions The better predictability of clinic outcome of CAP is APACHE Ⅱ score, PSI score, CURB-65 score, and PCT respectively in order, while the APACHE Ⅱ score and PCT concentration were independent risk factors for exacerbation and mortality in CAP patients. The predictive ability of a single PCT measurement is limited. The combination of APACHE Ⅱscore and PCT may increase specificity, but reduce sensitivity.
作者
王健珍
曹大伟
张新日
WANG Jianzhen;CAO Dawei;ZHANG Xinri(Department of Respiratory Medicine,the First Hospital of Shanxi Medical University,Taiyuan,Shanxi 030001,P.R.China)
出处
《中国呼吸与危重监护杂志》
CAS
CSCD
北大核心
2018年第5期456-460,共5页
Chinese Journal of Respiratory and Critical Care Medicine
基金
山西省科技产业化环境建设成果推广项目(2014071010)
关键词
社区获得性肺炎
预后评估
APACHEⅡ评分
降钙素原
PSI评分
Community-acquired pneumonia
Prognostic value
Acute Physiology and Chronic Health Evaluation Ⅱ
Procalcitonin
Pneumonia severity index scores
