Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Lung Research Institute of Hallym University, Chuncheon, Korea.
J Korean Med Sci. 2012 Aug;27(8):907-13. doi: 10.3346/jkms.2012.27.8.907. Epub 2012 Jul 25.
The purpose of this study was to investigate the clinical aspects of patients satisfying the Infectious Disease Society of America/American Thoracic Society (IDSA/ATS) minor severity criteria, focusing on their treatment response to empirical antibiotics. In total, 381 community-acquired pneumonia (CAP) patients who did not require mechanical ventilation or vasopressors at admission were enrolled, and 50 (13.1%) satisfied the minor severity criteria (i.e. , minor severe CAP [minor-SCAP]). The rates of new complication events and clinical treatment failure were significantly higher in the minor-SCAP group than in the control group (30.0% vs 2.1%, P < 0.001, and 42.0% vs 10.6%, P < 0.001, respectively), and the time to reach clinical stability was longer in the minor-SCAP group (8 days vs 3 days, P < 0.001). In a multivariate model, minor severity criteria (≥ 3) were significantly associated with treatment failure (odds ratio, 2.838; 95% confidence interval, 1.216 to 6.626), and for predicting treatment failure the value of the area under the receiver operating characteristic curve for minor criteria was 0.731, similar to other established scoring methods. The IDSA/ATS minor severity criteria can predict delayed treatment response and clinical treatment failure.
本研究旨在探讨符合美国传染病学会/美国胸科学会（IDSA/ATS）轻度严重程度标准的患者的临床特征，重点关注其对经验性抗生素治疗的反应。共纳入 381 例无需机械通气或升压药治疗的社区获得性肺炎（CAP）患者，其中 50 例（13.1%）符合轻度严重程度标准（即轻度重症 CAP [minor-SCAP]）。与对照组相比，minor-SCAP 组新发并发症事件和临床治疗失败的发生率显著更高（30.0%比 2.1%，P<0.001，和 42.0%比 10.6%，P<0.001），且 minor-SCAP 组达到临床稳定的时间更长（8 天比 3 天，P<0.001）。在多变量模型中，轻度严重程度标准（≥3）与治疗失败显著相关（比值比，2.838；95%置信区间，1.216 至 6.626），并且对于预测治疗失败，次要标准的受试者工作特征曲线下面积的价值为 0.731，与其他既定评分方法相似。IDSA/ATS 轻度严重程度标准可以预测治疗反应延迟和临床治疗失败。
