VA Western New York Healthcare System, Buffalo, NY 14215-1199, USA.
Chest. 2010 Dec;138(6):1371-6. doi: 10.1378/chest.10-0494. Epub 2010 May 27.
Several severity scores have been advanced to predict a patient's outcome from community-acquired pneumonia (CAP). The purpose of this study is to compare the accuracy of confusion, urea, respiratory rate, BP (CURB); CURB plus age ≥ 65 years (CURB-65); CURB-65 minus urea (CRB-65); and systolic BP, oxygenation, age, and respiratory rate (SOAR) scoring systems in predicting 30-day mortality and ICU admission in patients with nursing home-acquired pneumonia (NHAP).
A retrospective analysis of a prospectively collected database of 457 nursing home residents hospitalized with pneumonia at two university-affiliated tertiary care facilities. Clinical and laboratory features were used to compute severity scores using the British Thoracic Society severity rules and the SOAR criteria. The sensitivity, specificity, and positive and negative predictive values were compared for need for ICU admission and 30-day mortality.
The overall 30-day mortality and ICU admission rates were 23% and 25%, respectively. CURB, CURB-65, and CRB-65 performed similarly in predicting mortality with areas under the receiver operating characteristic curves (AUCs) of 0.605 (95% CI, 0.559-0.650), 0.593 (95% CI, 0.546-0.638), and 0.592 (95% CI, 0.546-0.638), respectively, whereas SOAR showed superior accuracy with an AUC of 0.765 (95% CI, 0.724-0.803) (P < .001). The need for ICU care was also better identified with the SOAR model compared with the other scoring rules.
All three British Thoracic Society rules had lower performance accuracy in predicting 30-day mortality of hospitalized NHAP than SOAR. SOAR is also a superior alternative for better identification of severe NHAP. An improved rule for severity assessment of hospitalized NHAP is needed.
已经有几种严重程度评分系统被提出，用于预测社区获得性肺炎（CAP）患者的预后。本研究旨在比较意识模糊、尿素、呼吸频率、血压（CURB）评分；CURB 加年龄≥65 岁（CURB-65）评分；CURB-65 减去尿素（CRB-65）评分；以及收缩压、氧合、年龄和呼吸频率（SOAR）评分系统在预测养老院获得性肺炎（NHAP）患者 30 天死亡率和 ICU 入住率方面的准确性。
对两家大学附属医院的 457 名养老院居民因肺炎住院的前瞻性数据库进行回顾性分析。使用英国胸科学会严重程度规则和 SOAR 标准计算临床和实验室特征的严重程度评分。比较需要 ICU 入住和 30 天死亡率的 ICU 入院和 30 天死亡率的敏感性、特异性、阳性和阴性预测值。
总的 30 天死亡率和 ICU 入住率分别为 23%和 25%。CURB、CURB-65 和 CRB-65 在预测死亡率方面表现相似，受试者工作特征曲线下面积（AUC）分别为 0.605（95%CI，0.559-0.650）、0.593（95%CI，0.546-0.638）和 0.592（95%CI，0.546-0.638），而 SOAR 的准确性更高，AUC 为 0.765（95%CI，0.724-0.803）（P<0.001）。与其他评分规则相比，SOAR 模型也能更好地识别需要 ICU 护理的患者。
三种英国胸科学会规则在预测 NHAP 住院患者 30 天死亡率方面的准确性均低于 SOAR。SOAR 也是更好地识别严重 NHAP 的替代方案。需要制定一种新的严重程度评估规则来评估 NHAP 患者。
