摘要
目的探讨快速序贯器官衰竭评分(q SOFA)、英国胸科协会改良肺炎评分(CURB-65)和简化CURB-65评分(CRB-65)三种评分系统预测重症社区获得性肺炎(severe community acquired pneumonia,SCAP)患者死亡的价值。方法收集2015年1月至2017年3月入住安徽医科大学第二附属医院呼吸内科的SCAP患者共164例,分析其一般临床资料,统计每例的q SOFA、CURB-65与CRB-65评分,比较各评分系统不同分值的患者间死亡率的差异,患者28天预后作为临床观察终点,以受试者工作特征曲线(ROC)来分析三种评分系统对SCAP严重程度的预测效能。结果最终纳入164例患者,28天死亡60例,死亡率为36.6%。三种评分系统中死亡组评分均明显高于存活组(P<0.05),且各评分系统中随着评分数值的升高SCAP死亡率均呈上升趋势(P<0.05)。ROC曲线分析显示,q SOFA、CURB-65、CRB-65评分三种评分系统均能预测SCAP患者28天的死亡风险,曲线下面积(AUC)分别是0.74(95%CI 0.63-0.84)、0.76(95%CI0.66-0.87)、0.74(95%CI 0.63-0.85),三者之间无统计学差异。结论新评分系统q SOFA也可预测重症社区获得性肺炎患者的严重程度,其预测效能与CURB-65、CRB-65评分相当,值得推广。
Objective To study the value of there different scoring systems,such as the quick Sepsis-related Organ Failure Assessment（ q SOFA）,the 6-point CURB-65 scale adopted by the British Thoracic Society and the simpler CRB-65 for assessing 28-day mortality in severe community-acquired pneumonia（ SCAP） patients. Methods The 164 patients with SCAP from January 2015 to March 2017 were collected and analyzed,the q SOFA,CURB-65 and CRB-65 scores were calculated respectively. The difference of 28-day mortality in each risk score of the different scoring systems were analyzed. According to prognosis of 28 days,we drew the receiver-operating characteristic（ ROC） curves of the three scoring systems and compared their area under the curve（ AUC） to determine the predictive value of severity. Results 164 patients were enrolled in this study and the overall mortality were 36. 6%. The q SOFA,CURB-65 and CRB-65 scores of the survival group were lower than those of the death group（ P〈0. 05）. All the three predictive rules showed the same trend of increasing mortality with the higher scores（ P〈0. 05）. For predicting 28-day mortality,the q SOFA,CURB-65 and CRB-65 performed similarly,and the areas under the receiver operating characteristic（ ROC） curve were 0. 735（ 95% CI 0. 627 to 0. 843）,0. 763（ 95% CI 0. 662 to 0. 865）and 0. 737（ 95% CI 0. 626 to 0. 848）,respectively. Conclusion The new scoring system q SOFA also can predict the severity of patients with severe community-acquired pneumonia. The q SOFA score,CURB-65 score and CRB-65 score have a similar performance in predicting the severity of SCAP patients.
作者
梅静
杨进
蒋建军
陆友金
MEI Jing;YANG Jin;JIANG Jian-jun;LU You-jin(Department of Respiratory Medicine, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230601, China)
出处
《临床肺科杂志》
2018年第6期1038-1042,共5页
Journal of Clinical Pulmonary Medicine
基金
国家自然科学基金(No 81400058)
安徽省科技攻关计划项目(No 1401045016)
