Background: Despiteits recommendation in management guide lines for community acquired pneumonia (CAP), the CURB65 score is frequently not followed for disposition decisions in clinical routine. We therefore proposed ...Background: Despiteits recommendation in management guide lines for community acquired pneumonia (CAP), the CURB65 score is frequently not followed for disposition decisions in clinical routine. We therefore proposed an improved CURB65 A score, supplemented by proadre nome dull in (ProADM) levels for patients with CAP and other lower respiratory tract infections (LRTIs). In this study, we vali dated this risk based biomarker enhanced disposition in patients with LRTIs presenting to the emergency department of the University Hospital of Basel. Methods: In this prospective observational cohort study of 85 patients presenting with LRTIs, site of care was decided by the physicians in charge according to their judgement. Retro spectively the CURB65 A score was calculated and a virtual disposition assigned. This was compared with the existing disposition in order to identify efficacy of the novel risk based biomarker enhanced disposition. Results: The novel disposition criteria considered 14 patients suitable for outpatient treatment compared to 11 in the current disposition (p = 0.5). It detected 7 patients to be best treated outside the hospital for nursing reasons, while the current disposition detected only 1 patient requiring geriatric care (p = 0.09). Further, it decreased regular hospitalizations considerably (32 vs. 64, p 0.001). Conclusions: The novel risk based biomarker enhanced disposition is an objective, safe and probably more efficient disposition system to identify outpatient treatment options than the current practice at the University Hospital of Basel.展开更多
目的采用肺炎严重度指数(pneumonia severity index,PSI)和CURB-65、急性生理学和慢性健康状况评分系统Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)三种评分系统对老年社区获得性肺炎(community-acquired pneumonia...目的采用肺炎严重度指数(pneumonia severity index,PSI)和CURB-65、急性生理学和慢性健康状况评分系统Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)三种评分系统对老年社区获得性肺炎(community-acquired pneumonia,CAP)危险度分层及严重程度和预后进行评估比较,以获得可靠的诊治依据。方法采用回顾性分析方法选取2012年1月至2015年4月上海市徐汇区大华医院呼吸内科住院收治的125例65岁以上老年CAP患者作为研究对象,分别在入院第1～3 d内进行PSI和CURB-65、APACHEⅡ评分,根据评分结果进行危险度分层,分为低危、中危、高危组。比较各组病死率和重症监护病房(intensive care unit,ICU)入住率,评估各系统预测死亡和入住ICU的敏感性、特异性、阳性预测值、阴性预测值、受试者工作特征(receiver operating characteristic,ROC)曲线下面积(area under ROC curve,AUC)、比较三种评分预测患者病死率方面两两之间的一致性及吻合度。结果 PSI、CURB-65、APACHEⅡ评分三种评分方法将大部分患者划分为低危组(分别为48.8%、64.0%、52.8%),划为中危组的患者分别为37.6%、23.2%、32.0%,小部分划为高危组(分别为13.6%、12.8%、15.2%)。PSI评分高危组、CURB-65评分高危组、APACHEⅡ评分高危组的病死率分别为41.3%、62.5%、47.4%,三种评分高危组ICU入住率分别为88.3%、100.0%、94.7%。PSI、CURB-65、APACHEⅡ三种评分预测死亡的敏感性分别为50.0%、71.4%、64.3%;三种评分预测入住ICU的敏感性分别为46.8%、50.0%、59.3%;而PSI、CURB-65、APACHEⅡ三种评分对预测死亡及入住ICU的特异性均在90%以上。三种评分预测死亡及入住ICU的AUC差别不大:PSI、CURB-65、APACHEⅡ三种评分预测死亡的AUC分别为0.893、0.871、0.880;三种评分预测入住ICU的AUC分别为0.949、0837、0.949。而三种评分预测患者死亡的风险两两之间的一致性均较好(P>0.05)。结论三种评分系统对预测老展开更多
Background Community-acquired pneumonia （CAP） remains one of the leading causes ot death from infectious diseases around the world.Most severe CAP patients are admitted to the intensive care unit （ICU）,and receive...Background Community-acquired pneumonia （CAP） remains one of the leading causes ot death from infectious diseases around the world.Most severe CAP patients are admitted to the intensive care unit （ICU）,and receive intense treatment.The present study aimed to evaluate the role of the pneumonia severity index （PSI）,CURB-65,and sepsis score in the management of hospitalized CAP patients and explore the effect of ICU treatment on prognosis of severe cases.Methods A total of 675 CAP patients hospitalized in the Second Affiliated Hospital of Zhejiang University School of Medicine were retrospectively investigated.The ability of different pneumonia severity scores to predict mortality was compared for effectiveness,while the risk factors associated with 30-day mortality rates and hospital length of stay （LOS） were evaluated.The effect of ICU treatment on the outcomes of severe CAP patients was also investigated.Results All three scoring systems revealed that the mortality associated with the low-risk or intermediate-risk group was significantly lower than with the high-risk group.As the risk level increased,the frequency of ICU admission rose in tandem and LOS in the hospital was prolonged.The areas under the receiver operating characteristic curve in the prediction of mortality were 0.94,0.91 and 0.89 for the PSI,CURB-65 and sepsis score,respectively.Compared with the corresponding control groups,the mortality was markedly increased in patients with a history of smoking,prior admission to ICU,respiratory failure,or co-morbidity of heart disease.The differences were also identified in LOS between control groups and patients with ICU treatment,heart,or cerebrovascular disease.Logistic regression analysis showed that age over 65 years,a history of smoking,and respiratory failure were closely related to mortality in the overall CAP cohort,whereas age,ICU admission,respiratory failure,and LOS at home between disease attack and hospital admission were identified as independent risk factors for mortality in th展开更多
目的：探讨 D-二聚体和成人社区获得性肺炎（CAP）严重程度的相关性。方法回顾性分析安徽医科大学第二附属医院呼吸科2011年1月~2015年4月收治102例成人 CAP 住院患者不同危险分组中D-二聚体变化情况及肺炎累及范围、有无合并胸腔积液对...目的：探讨 D-二聚体和成人社区获得性肺炎（CAP）严重程度的相关性。方法回顾性分析安徽医科大学第二附属医院呼吸科2011年1月~2015年4月收治102例成人 CAP 住院患者不同危险分组中D-二聚体变化情况及肺炎累及范围、有无合并胸腔积液对 D-二聚体的影响,观察不同组间的差异。按 CURB-65标准将102例患者分为低危组、中危组和高危组。结果低、中、高危 CAP 患者 D-二聚体异常率分别为62．1%（36/58）和100%（22/22）、95．4%（21/22）。中、高危组 CAP 患者 D-二聚体测定值分别为（3．007±0．329） ug/ ml、（5．404±1．394） ug/ ml,均显著高于低危组（1．068±0．134） ug/ ml、,差异均具有统计学意义（P〈0．05）,D-二聚体与肺炎严重程度存在等级相关性。多肺叶 CAP 患者 D-二聚体水平（3．235±0．528） ug/ ml较单肺叶（0．992±0．167） ug/ ml 明显增高,差异具有统计学意义（P〈0．05）。肺炎伴类肺炎性胸腔积液患者D-二聚体（3．154±0．501） ug/ ml 较未合并胸腔积液组（0．890±0．151） ug/ ml 显著增高,差异具有统计学意义（P〈0．05）。结论 CAP 患者血浆 D-二聚体显著升高,且与病情严重程度存在相关性,肺炎范围及是否合并胸腔积液影响凝血功能,推测 D-二聚体可能成为重症 CAP 患者良好的预测指标。展开更多
文摘Background: Despiteits recommendation in management guide lines for community acquired pneumonia (CAP), the CURB65 score is frequently not followed for disposition decisions in clinical routine. We therefore proposed an improved CURB65 A score, supplemented by proadre nome dull in (ProADM) levels for patients with CAP and other lower respiratory tract infections (LRTIs). In this study, we vali dated this risk based biomarker enhanced disposition in patients with LRTIs presenting to the emergency department of the University Hospital of Basel. Methods: In this prospective observational cohort study of 85 patients presenting with LRTIs, site of care was decided by the physicians in charge according to their judgement. Retro spectively the CURB65 A score was calculated and a virtual disposition assigned. This was compared with the existing disposition in order to identify efficacy of the novel risk based biomarker enhanced disposition. Results: The novel disposition criteria considered 14 patients suitable for outpatient treatment compared to 11 in the current disposition (p = 0.5). It detected 7 patients to be best treated outside the hospital for nursing reasons, while the current disposition detected only 1 patient requiring geriatric care (p = 0.09). Further, it decreased regular hospitalizations considerably (32 vs. 64, p 0.001). Conclusions: The novel risk based biomarker enhanced disposition is an objective, safe and probably more efficient disposition system to identify outpatient treatment options than the current practice at the University Hospital of Basel.
文摘目的采用肺炎严重度指数(pneumonia severity index,PSI)和CURB-65、急性生理学和慢性健康状况评分系统Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)三种评分系统对老年社区获得性肺炎(community-acquired pneumonia,CAP)危险度分层及严重程度和预后进行评估比较,以获得可靠的诊治依据。方法采用回顾性分析方法选取2012年1月至2015年4月上海市徐汇区大华医院呼吸内科住院收治的125例65岁以上老年CAP患者作为研究对象,分别在入院第1～3 d内进行PSI和CURB-65、APACHEⅡ评分,根据评分结果进行危险度分层,分为低危、中危、高危组。比较各组病死率和重症监护病房(intensive care unit,ICU)入住率,评估各系统预测死亡和入住ICU的敏感性、特异性、阳性预测值、阴性预测值、受试者工作特征(receiver operating characteristic,ROC)曲线下面积(area under ROC curve,AUC)、比较三种评分预测患者病死率方面两两之间的一致性及吻合度。结果 PSI、CURB-65、APACHEⅡ评分三种评分方法将大部分患者划分为低危组(分别为48.8%、64.0%、52.8%),划为中危组的患者分别为37.6%、23.2%、32.0%,小部分划为高危组(分别为13.6%、12.8%、15.2%)。PSI评分高危组、CURB-65评分高危组、APACHEⅡ评分高危组的病死率分别为41.3%、62.5%、47.4%,三种评分高危组ICU入住率分别为88.3%、100.0%、94.7%。PSI、CURB-65、APACHEⅡ三种评分预测死亡的敏感性分别为50.0%、71.4%、64.3%;三种评分预测入住ICU的敏感性分别为46.8%、50.0%、59.3%;而PSI、CURB-65、APACHEⅡ三种评分对预测死亡及入住ICU的特异性均在90%以上。三种评分预测死亡及入住ICU的AUC差别不大:PSI、CURB-65、APACHEⅡ三种评分预测死亡的AUC分别为0.893、0.871、0.880;三种评分预测入住ICU的AUC分别为0.949、0837、0.949。而三种评分预测患者死亡的风险两两之间的一致性均较好(P>0.05)。结论三种评分系统对预测老
基金This study was supported by grants from the National Natural Science Foundation of China （No.30871130 and 30500229）,the Qianjiang Talent Project of Science and Technology Department of Zhejiang Province （No.2010R10080）,and the Youth Talent Fund of Health Bureau of Zhejiang Province,China （No.2008QN016）.
文摘Background Community-acquired pneumonia （CAP） remains one of the leading causes ot death from infectious diseases around the world.Most severe CAP patients are admitted to the intensive care unit （ICU）,and receive intense treatment.The present study aimed to evaluate the role of the pneumonia severity index （PSI）,CURB-65,and sepsis score in the management of hospitalized CAP patients and explore the effect of ICU treatment on prognosis of severe cases.Methods A total of 675 CAP patients hospitalized in the Second Affiliated Hospital of Zhejiang University School of Medicine were retrospectively investigated.The ability of different pneumonia severity scores to predict mortality was compared for effectiveness,while the risk factors associated with 30-day mortality rates and hospital length of stay （LOS） were evaluated.The effect of ICU treatment on the outcomes of severe CAP patients was also investigated.Results All three scoring systems revealed that the mortality associated with the low-risk or intermediate-risk group was significantly lower than with the high-risk group.As the risk level increased,the frequency of ICU admission rose in tandem and LOS in the hospital was prolonged.The areas under the receiver operating characteristic curve in the prediction of mortality were 0.94,0.91 and 0.89 for the PSI,CURB-65 and sepsis score,respectively.Compared with the corresponding control groups,the mortality was markedly increased in patients with a history of smoking,prior admission to ICU,respiratory failure,or co-morbidity of heart disease.The differences were also identified in LOS between control groups and patients with ICU treatment,heart,or cerebrovascular disease.Logistic regression analysis showed that age over 65 years,a history of smoking,and respiratory failure were closely related to mortality in the overall CAP cohort,whereas age,ICU admission,respiratory failure,and LOS at home between disease attack and hospital admission were identified as independent risk factors for mortality in th
文摘目的：探讨 D-二聚体和成人社区获得性肺炎（CAP）严重程度的相关性。方法回顾性分析安徽医科大学第二附属医院呼吸科2011年1月~2015年4月收治102例成人 CAP 住院患者不同危险分组中D-二聚体变化情况及肺炎累及范围、有无合并胸腔积液对 D-二聚体的影响,观察不同组间的差异。按 CURB-65标准将102例患者分为低危组、中危组和高危组。结果低、中、高危 CAP 患者 D-二聚体异常率分别为62．1%（36/58）和100%（22/22）、95．4%（21/22）。中、高危组 CAP 患者 D-二聚体测定值分别为（3．007±0．329） ug/ ml、（5．404±1．394） ug/ ml,均显著高于低危组（1．068±0．134） ug/ ml、,差异均具有统计学意义（P〈0．05）,D-二聚体与肺炎严重程度存在等级相关性。多肺叶 CAP 患者 D-二聚体水平（3．235±0．528） ug/ ml较单肺叶（0．992±0．167） ug/ ml 明显增高,差异具有统计学意义（P〈0．05）。肺炎伴类肺炎性胸腔积液患者D-二聚体（3．154±0．501） ug/ ml 较未合并胸腔积液组（0．890±0．151） ug/ ml 显著增高,差异具有统计学意义（P〈0．05）。结论 CAP 患者血浆 D-二聚体显著升高,且与病情严重程度存在相关性,肺炎范围及是否合并胸腔积液影响凝血功能,推测 D-二聚体可能成为重症 CAP 患者良好的预测指标。
