Furtado G H, Wiskirchen D E, Kuti J L, Nicolau D P
Center for Anti-Infective Research and Development, Division of Infectious Diseases, Hartford Hospital, Connecticut, USA.
Anaesth Intensive Care. 2012 Mar;40(2):285-91. doi: 10.1177/0310057X1204000211.
The ventilator-associated pneumonia (VAP) PIRO score is a new scoring system based on the PIRO concept. The aim of this study was to validate the PIRO score against the Acute Physiology and Chronic Health Evaluation (APACHE) II and VAP APACHE II in an independent group of VAP patients. Areas under the receiver operating characteristic curves were compared to determine the tests' abilities to predict intensive care unit and 28-day mortality. Variables associated with intensive care unit mortality were evaluated. One hundred and forty-eight intensive care unit patients who met radiographic and clinical criteria for VAP were included. The area under the receiver operating characteristic curves for predicting intensive care unit mortality with the PIRO, APACHE II and VAP APACHE II scores were 0.605 (P=0.03), 0.631 (P=0.01) and 0.724 (P <0.0001), respectively. Areas under the receiver operating characteristic curve for predicting 28-day mortality were 0.614 (P=0.01) for PIRO, 0.633 (P=0.01) for APACHE II and 0.697 (P=0.002) for VAP APACHE II. No differences in area under the receiver operating characteristic curve between scores were found at either endpoint. Variables independently associated with intensive care unit mortality were bacteraemia (adjusted odds ratio 7.16, 95% confidence interval 1.19 to 42.98, P=0.03) and APACHE II (1.06, 1.01 to 1.11, P=0.006). VAP PIRO score was not a good predictor of intensive care unit and 28-day mortality. The low sensitivity and specificity of VAP PIRO score preclude its use clinically.
呼吸机相关性肺炎（VAP）PIRO评分是一种基于PIRO概念的新评分系统。本研究的目的是在一组独立的VAP患者中，对照急性生理与慢性健康状况评估（APACHE）II评分和VAP的APACHE II评分，验证PIRO评分。比较受试者工作特征曲线下面积，以确定这些测试预测重症监护病房（ICU）死亡率和28天死亡率的能力。评估与ICU死亡率相关的变量。纳入了148例符合VAP影像学和临床标准的ICU患者。PIRO、APACHE II和VAP的APACHE II评分预测ICU死亡率的受试者工作特征曲线下面积分别为0.605（P =0.03）、0.631（P =0.01）和0.724（P <0.0001）。PIRO评分预测28天死亡率的受试者工作特征曲线下面积为0.614（P =0.01），APACHE II评分为0.633（P =0.01），VAP的APACHE II评分为0.697（P =0.002）。在两个终点上，各评分之间的受试者工作特征曲线下面积均未发现差异。与ICU死亡率独立相关的变量是菌血症（校正比值比7.16，95%置信区间1.19至42.98，P =0.03）和APACHE II评分（1.06，1.01至1.11，P =0.006）。VAP PIRO评分不是ICU死亡率和28天死亡率的良好预测指标。VAP PIRO评分的低敏感性和特异性使其无法在临床上使用。
