社区获得性肺炎住院患者心脏并发症的风险分层。

Risk stratification for cardiac complications in patients hospitalized for community-acquired pneumonia.

机构信息

Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.

Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.

出版信息

Mayo Clin Proc. 2014 Jan;89(1):60-8. doi: 10.1016/j.mayocp.2013.09.015.

DOI:10.1016/j.mayocp.2013.09.015

PMID:24388023

Abstract

OBJECTIVE

To derive and validate a clinical rule that stratifies the risk of cardiac complications in patients hospitalized for community-acquired pneumonia (CAP) and compare its performance to the pneumonia severity index (PSI) score.

PATIENTS AND METHODS

Two cohorts of patients hospitalized for CAP were selected for the study. We used regression techniques in the derivation cohort (1343 patients enrolled in the Pneumonia Patient Outcomes Research Team study between October 1991 and March 1994) to generate a prediction rule that we validated in the validation cohort (608 patients enrolled in the Dissemination of Guidelines for Length of Stay study between February 1998 and March 1999). Discrimination and reclassification analyses compared its performance against the PSI score.

RESULTS

A prediction model for cardiac complications in the derivation cohort included age, 3 preexisting conditions, 2 vital signs, and 7 common laboratory or radiographic parameters. Discrimination (C statistic, 0.81; 95% CI, 0.78-0.84) and calibration (Hosmer-Lemeshow goodness-of-fit test, χ(2)=13.0; P=.11) were good. We derived a point score system from this model that when applied to the validation cohort also had good discrimination (C statistic, 0.78; 95% CI, 0.74-0.83) and calibration (Hosmer-Lemeshow, χ(2)=9.0; P=.34). On the basis of this score, we defined 4 categories of incremental risk of cardiac complications. The incidence of cardiac complications across risk categories increased linearly (from lowest to highest) in both the derivation (3.0%, 17.8%, 35.2%, and 72.2%) and validation (5.0%, 8.2%, 28.3%, and 48.9%) cohorts (Cochran-Armitage linear trend test, P<.01). The new score outperformed the PSI score in predicting cardiac complications in the validation cohort (C statistic, 0.78 vs 0.74; P=.03; proportion of patients correctly reclassified by the new score, 44%).

CONCLUSION

We derived and validated a clinical rule that accurately stratifies the risk of cardiac complications in patients hospitalized for CAP.

摘要

目的

制定并验证一种临床规则，以分层因社区获得性肺炎（CAP）住院患者的心脏并发症风险，并将其与肺炎严重指数（PSI）评分进行比较。

方法

选择了两批因 CAP 住院的患者进行研究。我们在推导队列（1991 年 10 月至 1994 年 3 月间参加肺炎患者结局研究小组研究的 1343 名患者）中使用回归技术生成预测规则，并在验证队列（1998 年 2 月至 1999 年 3 月间参加指南传播对住院时间影响研究的 608 名患者）中验证该规则。通过判别和重新分类分析比较其与 PSI 评分的性能。

结果

推导队列中用于心脏并发症预测的模型包括年龄、3 种既往疾病、2 种生命体征和 7 种常见实验室或影像学参数。判别（C 统计量，0.81；95%置信区间，0.78-0.84）和校准（Hosmer-Lemeshow 拟合优度检验，χ(2)=13.0；P=.11）都很好。我们从该模型中得出了一个点评分系统，当应用于验证队列时，也具有良好的判别能力（C 统计量，0.78；95%置信区间，0.74-0.83）和校准（Hosmer-Lemeshow，χ(2)=9.0；P=.34）。基于该评分，我们定义了心脏并发症风险的 4 个递增类别。在推导队列（从最低到最高）和验证队列（3.0%、17.8%、35.2%和 72.2%）中，心脏并发症的发生率都呈线性增加（Cochran-Armitage 线性趋势检验，P<.01）。在验证队列中，新评分在预测心脏并发症方面优于 PSI 评分（C 统计量，0.78 比 0.74；P=.03；新评分正确重新分类的患者比例，44%）。