Capelastegui A, España P P, Quintana J M, Bilbao A, Menendez R, Zalacain R, Torres A
Pneumology Service, Hospital Galdakao, Galdakao, Bizkaia, Spain.
Thorax. 2009 Jun;64(6):496-501. doi: 10.1136/thx.2008.098814. Epub 2009 Feb 22.
Although patients admitted to hospital for community-acquired pneumonia (CAP) experience substantial short-term mortality following hospital discharge, few studies have focused on identifying factors that predict mortality after admission to hospital in this population. The objective of this study was to develop and validate a prognostic index for 90-day mortality after hospital discharge among patients with CAP.
The prognostic index was derived in 1117 adult patients discharged between 2003 and 2007 from a general hospital following admission for CAP. It was validated in 646 consecutive patients with CAP discharged from three other hospitals between 1 November 2005 and 31 July 2006. Risk factors evaluated included host-related factors, severity upon admission, in-hospital management and bacteriology.
In the derivation cohort, three factors were independently associated with 90-day mortality: pre-illness functional status, Charlson index (composite measure of co-morbid illnesses) and severity on admission. Mortality at 90 days was 0.7% in the low-risk group, 3.5% in the intermediate-risk group and 17.2% in the high-risk group. In the validation cohort, 90-day mortality in the three groups was 0.6%, 3.9% and 19.6%, respectively. Compared with the low-risk group, the odds ratio for mortality was 43.5 for the high-risk group. The risk categories showed an area under the receiver operating characteristic curve of 0.79 in the derivation cohort and 0.82 in the validation cohort.
The prognostic index accurately stratifies patients admitted to hospital for CAP into low-, intermediate- and high-risk groups for 90-day mortality on discharge. The use of this index could help clinicians improve outcomes in this vulnerable population by targeting specific interventions to each group.
尽管因社区获得性肺炎（CAP）入院的患者在出院后经历了相当高的短期死亡率，但很少有研究专注于确定该人群入院后预测死亡率的因素。本研究的目的是开发并验证一个用于预测CAP患者出院后90天死亡率的预后指数。
该预后指数是从2003年至2007年间因CAP入院后从一家综合医院出院的1117例成年患者中得出的。它在2005年11月1日至2006年7月31日期间从其他三家医院出院的646例连续CAP患者中进行了验证。评估的危险因素包括宿主相关因素、入院时的严重程度、住院管理和细菌学。
在推导队列中，有三个因素与90天死亡率独立相关：病前功能状态、Charlson指数（合并疾病的综合测量）和入院时的严重程度。低风险组90天死亡率为0.7%，中风险组为3.5%，高风险组为17.2%。在验证队列中，三组90天死亡率分别为0.6%、3.9%和19.6%。与低风险组相比，高风险组的死亡比值比为43.5。风险类别在推导队列中的受试者工作特征曲线下面积为0.79，在验证队列中为0.82。
该预后指数能准确地将因CAP入院的患者分为出院后90天死亡率的低、中、高风险组。使用该指数可帮助临床医生针对每组采取特定干预措施，从而改善这一脆弱人群的预后。
