Myint Phyo K, Kamath Ajay V, Vowler Sarah L, Maisey David N, Harrison Brian D W
Department of Medicine for the Elderly, Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK.
Age Ageing. 2006 May;35(3):286-91. doi: 10.1093/ageing/afj081.
To assess the usefulness of the British Thoracic Society guidelines for severity assessment of community-acquired pneumonia (CAP) in predicting mortality and to explore alternative criteria which could be more useful in older patients.
Compilation study of two prospective observational cohorts.
A University hospital in Norfolk, UK with a catchment population of 568,000. Subjects were 195 patients (median age = 77 years) who were included in two prospective studies of CAP.
All-cause mortality occurring within the 6 week follow-up.
sensitivity, specificity, positive and negative predictive values for study outcome using CURB and CURB-65 were assessed in 189 patients, and CRB-65 in 192 patients out of a total of 195 patients. Our results were comparable with the original study by Lim et al. Although CURB-65 and CRB-65 included age criteria, in effect they did not materially improve the specificity in predicting high-risk patients in both studies. We found that oxygenation measured by ventilation perfusion mismatch (PaO2:FiO2) was the best predictor of outcome in this slightly older cohort [odds ratio (OR) = 0.99 (0.98-0.99), P = 0.0001]. We derived a new set of criteria; SOAR (systolic blood pressure, oxygenation, age and respiratory rate) based on our findings. Their sensitivity, specificity, positive and negative predictive values were 81.0% (58.1-94.6), 59.3% (49.6-68.4), 27.0% (16.6-39.7) and 94.4% (86.2-98.4), respectively, confirming their comparability with existing criteria.
Our Study confirms the usefulness of currently recommended severity rules for CAP in this older cohort. SOAR criteria may be useful as alternative criteria for a better identification of severe CAP in advanced age where both raised urea level above 7 mmol/l and confusion are common.
评估英国胸科学会社区获得性肺炎（CAP）严重程度评估指南在预测死亡率方面的实用性，并探索对老年患者可能更有用的替代标准。
两项前瞻性观察队列的汇总研究。
英国诺福克的一家大学医院，服务人口为568,000。研究对象为195例患者（中位年龄 = 77岁），他们被纳入两项CAP前瞻性研究。
6周随访内的全因死亡率。
在总共195例患者中，对189例患者使用CURB和CURB - 65评估研究结果的敏感性、特异性、阳性和阴性预测值，对192例患者使用CRB - 65评估。我们的结果与Lim等人的原始研究相当。尽管CURB - 65和CRB - 65纳入了年龄标准，但实际上在两项研究中它们在预测高危患者方面并未实质性提高特异性。我们发现，通过通气灌注不匹配（PaO2:FiO2）测量的氧合是这个年龄稍大的队列中结局的最佳预测指标[比值比（OR）= 0.99（0.98 - 0.99），P = 0.0001]。基于我们的研究结果，我们得出了一组新的标准；SOAR（收缩压、氧合、年龄和呼吸频率）。它们的敏感性、特异性、阳性和阴性预测值分别为81.0%（58.1 - 94.6）、59.3%（49.6 - 68.4）、27.0%（16.6 - 39.7）和94.4%（86.2 - 98.4），证实了它们与现有标准的可比性。
我们的研究证实了目前推荐的CAP严重程度规则在这个老年队列中的实用性。SOAR标准可能作为替代标准，用于更好地识别高龄患者中的严重CAP，在这些患者中尿素水平高于7 mmol/l和意识模糊都很常见。
