Chesov Dumitru, Rusu Doina, Munteanu Oxana, Brocovschii Victoria, Botnaru Victor
Universitatea de Stat de Medicină şi Farmacie Nicolae Testemiţanu Clinica Medicală nr. 2.
Pneumologia. 2012 Jan-Mar;61(1):37-43.
To compare the efficiency of some prognostic scores in patients with severe influenza pneumonias.
The study was performed on a cohort of 75 cases of 2009 AH1N1 influenza associated pneumonias. Clinical and laboratory features at admission were used to calculate retrospectively the following prognostic scores: SCAP (Severe Community Acquired Pneumonia), CAP-PIRO (Community Acquired Pneumonia--Predisposition Infection Reaction, Organ failure), SMRT-CO (Systolic blood pressure, Multilobar infiltrates, Respiration rate, Tachycardia, Confusion, Oxygen), IDSA/ATS (Infectious Diseases Society of America/American Thoracic Society). The scores were used to assess two different outcomes--death and need for invasive mechanical ventilation (IMV). The performance of the prognostic tools were assessed using the area under receiver operating characteristic (AUC), and the sensitivity and specificity for identifying high risk patients for severe course of pneumonia.
IMV was applied in 29 (38.7%) of studied cases, in 15 (20%) the diseases had a fatal outcome. Despite the fact that all scores had a very good discriminatory power in predicting both outcomes (AUC > 0,8), some of them have a very low sensitivity, in classes corresponding to sever pneumonias, in predicting mortality (IDSA/ATS-0%; 95% CI, 0-21.8%), as well as the need for IMV (IDSA/ATS-0%; 95% CI, 0-11.9%); SCAP-58.6% (95% CI, 38.9-76.5%); CAP-PIRO-58,6% (95% CI, 38.9-76.5%).
The CAP-PIRO and SMRT-CO scores were found to have the best performances to predict death from influenza associated severe pneumonias and the last, also in predicting the need for IVM. Other analyzed scores underestimate the risk of occurrence of both assessed outcomes.
比较一些预后评分系统对重症流感肺炎患者的评估效能。
本研究纳入了75例2009年甲型H1N1流感相关性肺炎患者。回顾性分析患者入院时的临床和实验室特征，计算以下预后评分：重症社区获得性肺炎（SCAP）评分、社区获得性肺炎-易感性感染反应、器官功能障碍（CAP-PIRO）评分、收缩压、多叶浸润、呼吸频率、心动过速、意识障碍、氧合（SMRT-CO）评分、美国感染病学会/美国胸科学会（IDSA/ATS）评分。这些评分用于评估两个不同结局——死亡和有创机械通气（IMV）需求。采用受试者工作特征曲线下面积（AUC）评估预后工具的性能，以及识别肺炎重症病程高危患者的敏感性和特异性。
29例（38.7%）研究病例接受了IMV，15例（20%）患者死亡。尽管所有评分在预测这两个结局方面都具有很好的区分能力（AUC>0.8），但其中一些评分在对应重症肺炎的类别中，预测死亡率时敏感性非常低（IDSA/ATS为0%；95%置信区间，0-21.8%），预测IMV需求时也是如此（IDSA/ATS为0%；95%置信区间，0-11.9%）；SCAP为58.6%（95%置信区间，38.9-76.5%）；CAP-PIRO为58.6%（95%置信区间，38.9-76.5%）。
发现CAP-PIRO和SMRT-CO评分在预测流感相关性重症肺炎死亡方面表现最佳，对于预测IMV需求也是如此。其他分析的评分低估了所评估的两个结局发生的风险。
