Dipartimento Toraco-polmonare e Cardio-circolatorio, University of Milan, Milan, Italy.
Int J Tuberc Lung Dis. 2009 Dec;13(12):1550-6.
The ability of the pneumonia severity index (PSI) and the CRB-65 to identify patients with low vs. high risk for mortality among cancer patients with CAP has not been evaluated.
Subjects with cancer, CAP/Ca(+), and without cancer, CAP/Ca(-), were identified from the Community-Acquired Pneumonia Organization database. Mortality for both groups was analyzed by comparing low vs. high risk for mortality for the PSI (Risk Class I, II and III vs. IV and V) and the CRB-65 score (scores 0 and 1 vs. 2, 3 and 4).
A total of 2621 patients were included in the CAP/Ca(-) group and 280 in the CAP/Ca(+) group. In the CAP/Ca(+) group, no significant difference in mortality was detected in low vs. high risk populations, either for the PSI (P = 0.288) or for the CRB-65 score (P = 0.281). Analyzing the receiver operator characteristic curves, the concordance indexes for the CAP/Ca(+) group were respectively 0.53 and 0.54 for PSI and CRB-65. By fitting a multivariable logistic regression model, a significantly different trend in mortality was found between the CAP/Ca(-) and CAP/Ca(+) groups for both scoring systems.
Clinical judgment will continue to be the physicians' primary tool in defining the site of care for cancer patients with CAP.
肺炎严重指数（PSI）和 CRB-65 用于评估 CAP 合并癌症患者的低危与高危死亡率的能力尚未得到评估。
从社区获得性肺炎组织数据库中确定患有癌症、CAP/Ca(+)且无癌症、CAP/Ca(-)的患者。通过比较 PSI（风险类别 I、II 和 III 与 IV 和 V）和 CRB-65 评分（评分 0 和 1 与 2、3 和 4）的低危与高危死亡率，对两组患者的死亡率进行分析。
共纳入 2621 例 CAP/Ca(-)组患者和 280 例 CAP/Ca(+)组患者。在 CAP/Ca(+)组中，PSI（P = 0.288）或 CRB-65 评分（P = 0.281）的低危与高危人群之间的死亡率均无显著差异。分析受试者工作特征曲线，PSI 和 CRB-65 对 CAP/Ca(+)组的一致性指数分别为 0.53 和 0.54。通过拟合多变量逻辑回归模型，发现两个评分系统在 CAP/Ca(-)和 CAP/Ca(+)组之间的死亡率存在显著差异。
临床判断将继续成为医生确定 CAP 合并癌症患者治疗场所的主要工具。
