Hoogewerf M, Oosterheert J J, Hak E, Hoepelman I M, Bonten M J M
Department of Internal Medicine and Infectious Diseases, University Medical Center, Utrecht, The Netherlands.
Clin Microbiol Infect. 2006 Nov;12(11):1097-104. doi: 10.1111/j.1469-0691.2006.01535.x.
For patients with community-acquired pneumonia (CAP), clinical response during the first days of treatment is predictive of clinical outcome. As risk assessments can improve the efficiency of pneumonia management, a prospective cohort study to assess clinical, biochemical and microbiological predictors of early clinical failure was conducted in patients with severe CAP (pneumonia severity index score of >90 or according to the American Thoracic Society definition). Failure was assessed at day 3 and was defined as death, a need for mechanical ventilation, respiratory rate >25/min, PaO2 <55 mm Hg, oxygen saturation <90%, haemodynamic instability, temperature >38 degrees C or confusion. Of 260 patients, 80 (31%) had early clinical failure, associated mainly with a respiratory rate >25/minute (n = 34), oxygen saturation <90% (n = 28) and confusion (n = 20). In multivariate logistic regression analysis, failure was associated independently with altered mental state (OR 3.19, 95% CI 1.75-5.80), arterial PaH <7.35 mm Hg (OR 4.29, 95% CI 1.53-12.05) and PaO2 <60 mm Hg (OR 1.75, 95% CI 0.97-3.15). A history of heart failure was associated inversely with clinical failure (OR 0.30, 95% CI 0.10-0.96). Patients who failed to respond had a higher 28-day mortality rate and a longer hospital stay. It was concluded that routine clinical and biochemical information can be used to predict early clinical failure in patients with severe CAP.
对于社区获得性肺炎（CAP）患者，治疗开始数天内的临床反应可预测临床结局。由于风险评估可提高肺炎管理效率，因此对重症CAP患者（肺炎严重程度指数评分>90或根据美国胸科学会定义）进行了一项前瞻性队列研究，以评估早期临床治疗失败的临床、生化和微生物学预测因素。在第3天评估治疗失败情况，定义为死亡、需要机械通气、呼吸频率>25次/分钟、动脉血氧分压（PaO2）<55 mmHg、氧饱和度<90%、血流动力学不稳定、体温>38摄氏度或意识模糊。260例患者中，80例（31%）出现早期临床治疗失败，主要与呼吸频率>25次/分钟（n = 34）、氧饱和度<90%（n = 28）和意识模糊（n = 20）有关。在多因素逻辑回归分析中，治疗失败独立与精神状态改变（比值比[OR] 3.19，95%置信区间[CI] 1.75 - 5.80）、动脉血pH<7.35 mmHg（OR 4.29，95% CI 1.53 - 12.05）和PaO2<60 mmHg（OR 1.75，95% CI 0.97 - 3.15）相关。心力衰竭病史与临床治疗失败呈负相关（OR 0.30，95% CI 0.10 - 0.96）。治疗无反应的患者28天死亡率更高，住院时间更长。研究得出结论，常规临床和生化信息可用于预测重症CAP患者的早期临床治疗失败。
