Bont J, Hak E, Hoes A W, Schipper M, Schellevis F G, Verheij T J M
Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, PO Box 85060, 3508 AB Utrecht, The Netherlands.
Eur Respir J. 2007 May;29(5):969-75. doi: 10.1183/09031936.00129706. Epub 2007 Jan 10.
Prognostic scores for lower respiratory tract infections (LRTI) have been mainly derived in a hospital setting. The current authors have developed and validated a prediction rule for the prognosis of acute LRTI in elderly primary-care patients. Data including demographics, medication use, healthcare use and comorbid conditions from 3,166 episodes of patients aged > or =65 yrs visiting the general practitioner (GP) with LRTI were collected. Multiple logistic regression analysis was used to construct a predictive model. The main outcome measure was 30-day hospitalisation or death. The Second Dutch Survey of GPs was used for validation. The following were independent predictors of 30-day hospitalisation or death: increasing age; previous hospitalisation; heart failure; diabetes; use of oral glucocorticoids; previous use of antibiotics; a diagnosis of pneumonia; and exacerbation of chronic obstructive pulmonary disease. A prediction rule based on these variables showed that the outcome increased directly with increasing scores: 3, 10 and 31% for scores of <2 points, 3-6 and > or =7 points, respectively. Corresponding figures for the validation cohort were 3, 11 and 26%, respectively. This simple prediction rule can help the primary-care physician to differentiate between high- and low-risk patients. As a possible consequence, low-risk patients may be suitable for home treatment, whereas high-risk patients might be monitored more closely in a homecare or hospital setting. Future studies should assess whether information on signs and symptoms can further improve this prediction rule.
下呼吸道感染（LRTI）的预后评分主要是在医院环境中得出的。本文作者针对老年初级保健患者急性LRTI的预后制定并验证了一种预测规则。收集了3166例年龄≥65岁因LRTI就诊于全科医生（GP）的患者的数据，包括人口统计学信息、用药情况、医疗保健利用情况和合并症。采用多元逻辑回归分析构建预测模型。主要结局指标为30天内住院或死亡。使用第二次荷兰全科医生调查进行验证。以下因素是30天内住院或死亡的独立预测因素：年龄增加；既往住院史；心力衰竭；糖尿病；口服糖皮质激素的使用；既往抗生素使用史；肺炎诊断；以及慢性阻塞性肺疾病加重。基于这些变量的预测规则显示，随着评分增加，结局直接上升：评分＜2分、3 - 6分和≥7分的患者，其结局分别为3%、10%和31%。验证队列的相应数字分别为3%、11%和26%。这种简单的预测规则可帮助初级保健医生区分高风险和低风险患者。可能的结果是，低风险患者可能适合在家治疗，而高风险患者可能需要在家庭护理或医院环境中进行更密切的监测。未来的研究应评估关于体征和症状的信息是否能进一步改进这一预测规则。
