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各种肺炎严重程度模型的性能,用于预测社区获得肺炎的老年住院患者的不良结果
Lixue Huang1, Bingxuan Weng1, Xiaoying Gu2
1Department of Pulmonary and Critical Care Medicine, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, China.
像PSI,CURB-65和SMART-COP这样的肺炎严重程度得分可以预测老年患者的结果. 肺炎严重性指数 (PSI) 最好预测死亡率,而SMART-COP和CURB-65对于临床使用更简单.
科学领域:
- 老年医学 老年医学
- 传染性疾病 传染性疾病
- 临床流行病学临床流行病学
背景情况:
- 社区获得性肺炎 (CAP) 对老年人群构成重大风险.
- 准确评估肺炎的严重程度对于老年人及时和适当的治疗至关重要.
- 现有几种评分系统可以预测肺炎的结果,但它们在老年人中的比较表现尚未得到充分证实.
研究的目的:
- 为了评估五种常见的肺炎严重性评分的预测性表现:肺炎严重性指数 (PSI),CURB-65,CRB-65,A-DROP和SMART-COP.
- 确定最佳的评分系统,以预测社区获得性肺炎的老年患者的不良结果.
- 为了比较这些分数的准确性和临床实用性,用于特定的结果,包括死亡率,机械通风和ICU入院.
主要方法:
- 追溯队列研究,包括822名被诊断患有社区获得性肺炎的老年住院患者.
- 基于入院临床和实验室数据计算PSI,CURB-65,CRB-65,A-DROP和SMART-COP得分.
- 使用接收器运行特征曲线 (AUCs) 下的区域对初级 (30天死亡率) 和二次结果 (住院死亡率,机械通风,ICU入院) 的模型歧视评估.
主要成果:
- 30天和住院死亡率分别为6.8%和8.6%. 24.0%的患者需要机械通风,13.5%的患者需要接受ICU治疗.
- 所有评分系统都显示出一个统计学上显著的趋势,即随着风险组分层更高,不良结果的增加 (p < 0.001).
- 肺炎严重性指数 (PSI) 显示出最高的AUC,灵敏度和负预测值 (NPV) 来预测30天和住院死亡率. 在预测机械通风和ICU入院方面,SMART-COP显示了最高的AUC,尽管PSI对这些结果具有更高的灵敏度和NPV.
结论:
- 肺炎严重性指数 (PSI) 是一种非常有效的工具,用于识别30天死亡风险的老年CAP患者,其高NPV有助于排除高风险个体.
- 虽然PSI在死亡率预测方面表现出色,但SMART-COP和CURB-65提供了有效性和简单性的平衡,使它们在老年人CAP管理中的常规临床应用更加实用.
- 评分系统的选择可能取决于特定的利益结果以及临床环境的资源和优先事项.
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