肺炎严重指数与 CRB-65 对临床稳定时间的预测准确性：来自社区获得性肺炎组织（CAPO）国际队列研究的结果。

Predictive accuracy of the pneumonia severity index vs CRB-65 for time to clinical stability: results from the Community-Acquired Pneumonia Organization (CAPO) International Cohort Study.

机构信息

University of Louisville, School of Medicine, Department of Medicine, Division of Infectious Diseases, Louisville, KY 40202, USA.

出版信息

Respir Med. 2010 Nov;104(11):1736-43. doi: 10.1016/j.rmed.2010.05.022. Epub 2010 Jun 23.

DOI:10.1016/j.rmed.2010.05.022

PMID:20576417

Abstract

BACKGROUND

The Pneumonia Severity Index (PSI) and CRB-65 are scores used to predict mortality in patients with community-acquired pneumonia (CAP). It is unknown how well either score predicts time to clinical stability in hospitalized patients with CAP. Thus, it is also not known which score predicts time to clinical stability better.

METHODS

A secondary analysis of 3087 patients from the Community-Acquired Pneumonia Organization (CAPO) database was performed. Time-dependent receiver-operator characteristic (ROC) curves for time to clinical stability were calculated for the PSI and CRB-65 scores at day seven of hospitalization. Secondary outcomes were to assess the relationship of the PSI and CRB-65 to in-hospital mortality and length of stay (LOS). ROC curves for LOS and mortality were calculated.

RESULTS

The area under the ROC curve (AUC) for time to clinical stability by day seven was 0.638 (95% CI 0.613, 0.660) when using the PSI, and 0.647 (95% CI 0.619, 0.670) while using the CRB-65. The difference in AUC values was not statistically significant (95% CI for difference of -0.03 to 0.01). However, the difference in the AUC values for discharge within 14 days (0.651 for PSI vs 0.63 for CRB-65, 95% CI for difference 0.001-0.049), and 28-day in-hospital mortality (0.738 for PSI vs 0.69 for CRB-65, 95% CI for difference 0.02-0.082) were both statistically significant.

CONCLUSIONS

This study demonstrates a moderate ability of both the PSI and CRB-65 scores to predict time to clinical stability, and found that the predictive accuracy of the PSI was equivalent to that of the CRB-65 for this outcome.

摘要

背景

肺炎严重指数（PSI）和 CRB-65 是用于预测社区获得性肺炎（CAP）患者死亡率的评分。目前尚不清楚这两个评分在预测 CAP 住院患者临床稳定所需时间方面的效果如何。因此，也不清楚哪个评分能更好地预测临床稳定所需时间。

方法

对社区获得性肺炎组织（CAPO）数据库中的 3087 例患者进行二次分析。在住院第 7 天，计算 PSI 和 CRB-65 评分预测临床稳定时间的时间依赖性受试者工作特征（ROC）曲线。次要结局为评估 PSI 和 CRB-65 与住院死亡率和住院时间（LOS）的关系。计算 LOS 和死亡率的 ROC 曲线。

结果

PSI 预测临床稳定时间的 ROC 曲线下面积（AUC）为 0.638（95%CI，0.613-0.660），而 CRB-65 的 AUC 为 0.647（95%CI，0.619-0.670）。AUC 值的差异无统计学意义（95%CI 差值为-0.03 至 0.01）。然而，PSI 预测 14 天内出院（PSI 的 AUC 为 0.651，CRB-65 的 AUC 为 0.63，95%CI 差值为 0.001-0.049）和 28 天住院死亡率（PSI 的 AUC 为 0.738，CRB-65 的 AUC 为 0.69，95%CI 差值为 0.02-0.082）的 AUC 值差异均有统计学意义。