Yoshimoto Akihiro, Nakamura Hiroyuki, Fujimura Masaki, Nakao Shinji
Department of Hematology-Oncology and Respiratory Medicine, Cellular Transplantation Biology, Kanazawa University Graduate School of Medical Science, Kanazawa.
Intern Med. 2005 Jul;44(7):710-6. doi: 10.2169/internalmedicine.44.710.
To evaluate severe community-acquired pneumonia (SCAP) patients in an intensive care unit (ICU) with regard to risk factors for mortality and to compare ICU patients with matched non-ICU patients to evaluate whether our judgement for ICU admission was appropriate or not.
During a 7-year period, all patients with CAP who were admitted to the ICU were examined. They underwent clinical and radiographic evaluations, and two commonly used severity of illness scores were also calculated using the Simplified Acute Physiological Score (SAPS) and the Acute Physiology and Chronic Health Evaluation (APACHE) II methods. To detect risk factors for ICU admission using existing guidelines, each study patient was matched with two patients hospitalized in a general medical ward.
Seventy-two patients were identified during the study period. Their mean age was 72.9 years, and 35 patients (48.6%) subsequently died. For the univariate analysis, there were significant differences with the pulse rate > or = 130/min, blood urea nitrogen > or = 30 mg/dl, multilobar shadow, SAPS > or = 13, APACHE II > or = 23, and the occurrence of septic shock between the survivors and those who died. For the multivariate analysis, septic shock (p = 0.0005, odds ratio of 26.6) and blood urea nitrogen > or = 30 mg/dl (p = 0.037, odds ratio of 5.38) were associated with mortality. Regarding the characteristics of different clinical predictions for ICU admission, the revised American Thoracic Society criteria might have been the most accurate.
Septic shock was associated with high mortality, which is a more accurate and higher predictor of mortality than was physical examination, laboratory or radiographic findings.
评估重症监护病房（ICU）中重症社区获得性肺炎（SCAP）患者的死亡危险因素，并将ICU患者与匹配的非ICU患者进行比较，以评估我们对ICU入院的判断是否恰当。
在7年期间，对所有入住ICU的社区获得性肺炎患者进行检查。他们接受了临床和影像学评估，并使用简化急性生理学评分（SAPS）和急性生理学与慢性健康状况评估（APACHE）II方法计算了两个常用的疾病严重程度评分。为了根据现有指南检测ICU入院的危险因素，将每位研究患者与两名在普通内科病房住院的患者进行匹配。
研究期间共确定了72例患者。他们的平均年龄为72.9岁，35例患者（48.6%）随后死亡。单因素分析显示，存活者与死亡者在心率≥130次/分钟、血尿素氮≥30mg/dl、多叶阴影、SAPS≥13、APACHE II≥23以及感染性休克的发生方面存在显著差异。多因素分析显示，感染性休克（p = 0.0005，比值比为26.6）和血尿素氮≥30mg/dl（p = 0.037，比值比为5.38）与死亡率相关。关于ICU入院不同临床预测的特征，修订后的美国胸科学会标准可能是最准确的。
感染性休克与高死亡率相关，与体格检查、实验室或影像学检查结果相比，它是更准确、更高的死亡率预测指标。
