Norwich Medical School, Faculty of Medicine and Health Sciences, United Kingdom.
Am J Med Sci. 2011 Dec;342(6):489-93. doi: 10.1097/MAJ.0b013e31822cb95f.
Community-acquired pneumonia (CAP) is common and associated with a significant mortality. Currently recommended criteria to assess severity of CAP could be improved.
We derived 2 new criteria CARSI [confusion, age (<65, ≥65 to <85 or≥ 85), respiratory rate and shock index] and CARASI, where shock index is replaced by temperature-adjusted shock index based on previous observations. By using data of a prospective study performed in Norfolk and Suffolk, United Kingdom, we compare these new indices with the CURB-65 criteria.
A total of 190 patients were included (men, 53%). The age range was 18 to 101 years (median, 76 years). There were a total of 54 deaths during a 6-week follow-up, all within 30 days of admission. Sixty-five (34%) had severe pneumonia by CURB-65. Using CARSI and CARASI, 39 (21%) and 36 (19%) had severe pneumonia, respectively. Sensitivity was slightly less, but specificity was higher with CARSI and CARASI indices than that of CURB-65. Positive and negative predictive values in predicting death during 6-week follow-up were comparable among 3 indices examined. The receiver operating characteristic curve values (95% confidence interval) for the criteria were 0.67 (0.60-0.75) for CURB-65, 0.64 (0.60-0.71) for CARSI and 0.64 (0.57-0.71) for CARASI. Comparing receiver operating characteristic curves for CURB-65 versus CARSI, or CURB-65 versus CARASI, there was no evidence of a difference between the tools, P = 0.35 and 0.33, respectively. There was good agreement, which was strongly statistically significant (kappa = 0.56, P < 0.0001 and kappa = 0.54, P < 0.0001, respectively).
Both CARSI and CARASI are useful in predicting deaths associated with CAP, including older patients, and may be particularly useful in the emergency and community settings.
社区获得性肺炎（CAP）很常见，与较高的死亡率相关。目前用于评估 CAP 严重程度的推荐标准可能需要改进。
我们推导出 2 个新的标准 CARSI（意识障碍、年龄（<65 岁、≥65 岁至<85 岁或≥85 岁）、呼吸频率和休克指数）和 CARASI，其中休克指数由基于既往观察结果的校正体温休克指数替代。利用在英国诺福克和萨福克进行的前瞻性研究的数据，我们将这些新标准与 CURB-65 标准进行了比较。
共纳入 190 例患者（男性占 53%）。年龄范围为 18 岁至 101 岁（中位数为 76 岁）。在 6 周的随访期间，共有 54 例患者死亡，均发生在入院后 30 天内。65 例（34%）根据 CURB-65 标准患有严重肺炎。使用 CARSI 和 CARASI 标准，分别有 39 例（21%）和 36 例（19%）患有严重肺炎。CARSI 和 CARASI 标准的敏感性略低，但特异性高于 CURB-65。在预测 6 周随访期间死亡的阳性和阴性预测值在 3 项检查中相似。标准的受试者工作特征曲线值（95%置信区间）为 CURB-65 为 0.67（0.60-0.75），CARSI 为 0.64（0.60-0.71），CARASI 为 0.64（0.57-0.71）。比较 CURB-65 与 CARSI 或 CURB-65 与 CARASI 的受试者工作特征曲线，工具之间没有差异，P 值分别为 0.35 和 0.33。有很好的一致性，具有统计学意义（kappa = 0.56，P<0.0001 和 kappa = 0.54，P<0.0001）。
CARSI 和 CARASI 均有助于预测 CAP 相关死亡，包括老年患者，在急诊和社区环境中可能特别有用。
