Department of Respiratory Medicine, Affiliated Futian Hospital, Guangdong Medical College, Shennan Middle Road 3025, Shenzhen, Guangdong, China.
Respir Med. 2011 Oct;105(10):1543-9. doi: 10.1016/j.rmed.2011.06.010. Epub 2011 Jul 20.
The 2007 Infectious Disease Society of America (IDSA)/American Thoracic Society (ATS) guidelines defined severe community-acquired pneumonia (CAP) when patients fulfilled three out of nine minor criteria. Whether each of the criteria is of equal weight is not clear. The purpose of this study was to determine the weight of the minor criteria.
1230 adult patients admitted to our hospital from 2005 to 2009 for CAP were reviewed retrospectively.
Hospital mortality rose sharply from 0.3%, 1.0% and 3.3%, respectively, for patients with none, one and two minor criteria to 10.5% for patients with three minor criteria. Arterial oxygen pressure/fraction inspired oxygen (PaO(2)/FiO(2)) ≤ 250 mm Hg, confusion, and uremia had the strongest association with mortality (Odds ratio, 22.162, 22.148, 16.343; respectively). Leukopenia, hypothermia, and hypotension were not associated with mortality. Confusion and uremia showed independent relationships with mortality (Odds ratio, 9.296, 8.493; respectively). Sequential organ failure assessment (SOFA) scores and costs increased significantly with the number of minor criteria present. Uremia and PaO(2)/FiO(2) ≤ 250 mm Hg were most strongly associated with SOFA scores [rank correlation coefficient (r(s)), 0.352, 0.336; respectively]. PaO(2)/FiO(2) ≤ 250 mm Hg and confusion were in closest relation to hospital length of stay (LOS) (r(s), 0.114, 0.114; respectively). PaO(2)/FiO(2) ≤ 250 mm Hg and multilobar infiltrates were most strongly associated with costs (r(s), 0.257, 0.196; respectively).
The individual 2007 IDSA/ATS minor criteria for severe CAP were of unequal weight in predicting hospital mortality, SOFA scores, hospital LOS, and costs.
2007 年美国传染病学会（IDSA）/美国胸科学会（ATS）指南将满足 9 项次要标准中的 3 项的社区获得性肺炎（CAP）定义为重症 CAP。但每项标准的权重并不明确。本研究旨在确定这些次要标准的权重。
回顾性分析了我院 2005 年至 2009 年收治的 1230 例成人 CAP 患者。
无、1 项和 2 项次要标准的患者住院死亡率分别为 0.3%、1.0%和 3.3%，而 3 项次要标准的患者死亡率高达 10.5%。动脉血氧分压/吸氧分数（PaO2/FiO2）≤250mmHg、意识障碍和尿毒症与死亡率的关联最强（比值比，22.162、22.148、16.343；分别）。白细胞减少、低体温和低血压与死亡率无关。意识障碍和尿毒症与死亡率呈独立关系（比值比，9.296、8.493；分别）。随着次要标准数目的增加，序贯器官衰竭评估（SOFA）评分和费用显著增加。尿毒症和 PaO2/FiO2≤250mmHg 与 SOFA 评分的关联最强（秩相关系数（r(s)），0.352、0.336；分别）。PaO2/FiO2≤250mmHg 和意识障碍与住院时间（LOS）的关系最密切（r(s)，0.114、0.114；分别）。PaO2/FiO2≤250mmHg 和多肺叶浸润与费用的关联最强（r(s)，0.257、0.196；分别）。
2007 年 IDAS/ATS 重症 CAP 的个别次要标准在预测住院死亡率、SOFA 评分、住院 LOS 和费用方面的权重并不相等。
