Saldías Fernando, Farías Gonzalo, Villarroel Luis, Valdivia Gonzalo, Mardónez José Miguel, Díaz Alejandro
Departamento de Enfermedades Respiratorias, Pontificia Universidad Católica de Chile, Santiago.
Rev Med Chil. 2004 Sep;132(9):1037-46. doi: 10.4067/s0034-98872004000900003.
Community acquired pneumonia (CAP) severity assessment is crucial.
To develop a practical clinical severity assessment model for stratifying immunocompetent adult patients hospitalized with CAP into different management groups.
During a 24 months period, 455 adult patients (250 male, mean age 69 +/- 19 years old) were evaluated. All the relevant clinical information recorded and they were followed during hospital stay until discharge or death. Mortality until 30 days after admission was determined.
The mean hospital length of stay was 9.9 +/- 9.4 days and 76% had an underlying disease. In hospital mortality was 7.6% and 10.1% at 30 days follow up. Admission prognostic factors associated with high mortality at 30 days follow up were: advanced age, presence of comorbidity, suspicion of aspiration, duration of symptoms < or = 2 days, altered mental status, absence of cough, fever and cbills, low blood pressure, tachypnea, hypoxemia and multilobar radiographic pulmonary infiltrates. A clinical prognostic index derived from a logistic regression analysis including five independent variables associated with mortality (confuson, comorbidity, low systolic blood pressure, temperature < 37.5 degrees C and respiratory rate > 20/min), enabled patients to be stratified according to increasing risk of mortality: class 1: 0.9%, class 2: 4.9%, class 3: 14.2%, and class 4: 35.6%.
A simple clinical severity assessment tool based on confusion, comorbidity, blood pressure, temperature and respiratory rate could be used to stratify patients with CAP into different risk class categories and management groups.
社区获得性肺炎（CAP）严重程度评估至关重要。
建立一个实用的临床严重程度评估模型，用于将因CAP住院的免疫功能正常的成年患者分层到不同的管理组。
在24个月期间，对455例成年患者（250例男性，平均年龄69±19岁）进行了评估。记录了所有相关临床信息，并在住院期间对他们进行随访直至出院或死亡。确定了入院后30天内的死亡率。
平均住院时间为9.9±9.4天，76%的患者有基础疾病。住院死亡率为7.6%，30天随访时为10.1%。与30天随访时高死亡率相关的入院预后因素包括：高龄、合并症、怀疑有误吸、症状持续时间≤2天、精神状态改变、无咳嗽、发热和寒战、低血压、呼吸急促、低氧血症和多叶肺部影像学浸润。通过逻辑回归分析得出的一个临床预后指数，包括与死亡率相关的五个独立变量（意识模糊、合并症、收缩压低、体温<37.5℃和呼吸频率>20次/分钟），能够根据死亡率风险增加对患者进行分层：1级：0.9%，2级：4.9%，3级：14.2%，4级：35.6%。
一种基于意识模糊、合并症、血压、体温和呼吸频率的简单临床严重程度评估工具，可用于将CAP患者分层到不同的风险类别和管理组。
