University of Witwatersrand, Johannesburg, South Africa.
J Intensive Care Med. 2011 Jan-Feb;26(1):34-40. doi: 10.1177/0885066610383949.
Patients with community-acquired pneumonia (CAP) comprised 35.6% of the overall phase 3 Recombinant Human Activated Protein C Worldwide Evaluation in Severe Sepsis (PROWESS) study and 33.1% of the placebo arm. We investigated the use of CURB-65, the Pneumonia Severity Index (PSI), and Acute Physiology and Chronic Health Evaluation II (APACHE II) prediction scores to identify the CAP population from the PROWESS placebo arm at the greatest mortality risk.
Patients were classified as having CAP if the lung was the primary infection site and the patient originated from home. The abilities of CURB-65, PSI, and APACHE II scores to determine the 28-day and in-hospital mortality were compared using receiver operator characteristic (ROC) curves and the associated areas under the curve.
PROWESS enrolled 278 patients with CAP in the placebo arm. The areas under the ROC curves for PSI = 5, CURB-65 ≥ 3, and APACHE II ≥ 25 for predicting 28-day (c = 0.65, 0.66, and 0.64, respectively) and in-hospital mortality (c = 0.65, 0.65, and 0.64, respectively) were not statistically different from each other. The 28-day mortality of patients with a PSI score of 5, CURB-65 ≥ 3, and APACHE II ≥ 25 was 41.6%, 37.9%, and 43.5%, respectively.
Despite early diagnosis and appropriate antibiotic therapy, conventionally treated CAP with PSI = 5, CURB-65 3, or APACHE II 25 has an unacceptably high mortality. In this study, PSI, CURB-65, and APACHE II scoring systems perform similarly in predicting the 28-day and in-hospital mortality; however, differences in the categorization of severe CAP were observed and there was a significant mortality in patients with a CURB-65 <3 and PSI <5.
社区获得性肺炎（CAP）患者占重组人活化蛋白 C 治疗严重脓毒症全球疗效评价研究（PROWESS）全部病例的 35.6%，占安慰剂组的 33.1%。我们旨在应用 CURB-65、肺炎严重指数（PSI）和急性生理学与慢性健康状况评分系统Ⅱ（APACHE II）评分预测指标，从 PROWESS 安慰剂组中筛选出病死率最高的 CAP 患者。
如果肺部为原发感染部位且患者来源于社区，即可诊断为 CAP。应用受试者工作特征（ROC）曲线及其曲线下面积（AUC）比较 CURB-65、PSI 和 APACHE II 评分对 28 天及住院病死率的预测能力。
PROWESS 安慰剂组共纳入 278 例 CAP 患者。PSI = 5、CURB-65 ≥ 3 和 APACHE II ≥ 25 预测 28 天病死率的 AUC 分别为 0.65、0.66 和 0.64，预测住院病死率的 AUC 分别为 0.65、0.65 和 0.64，各项之间无统计学差异。PSI 评分 5、CURB-65 ≥ 3 和 APACHE II ≥ 25 的患者 28 天病死率分别为 41.6%、37.9%和 43.5%。
尽管 CAP 患者得到早期诊断和恰当的抗生素治疗，但按传统标准诊断和治疗的 CAP 患者，PSI = 5、CURB-65 ≥ 3 或 APACHE II ≥ 25 时病死率仍居高不下。本研究中，PSI、CURB-65 和 APACHE II 评分系统对预测 28 天及住院病死率的效能相当，但严重 CAP 的分类存在差异，且 CURB-65 < 3 和 PSI < 5 的患者病死率显著升高。
