Matsunuma R, Asai N, Ohkuni Y, Nakashima K, Iwasaki T, Misawa M, Norihiro K
Department of Pulmonology, Kameda Medical Center, 929 Higashi-cho, Kamogawa City, Chiba Prefecture, Japan 296-8602.
Singapore Med J. 2014 Jun;55(6):318-24. doi: 10.11622/smedj.2014082.
The ability to predict the prognosis of patients with pneumonia is critical, especially when making decisions regarding treatment regimens and sites of care. However, prognostic guidelines for healthcare-associated pneumonia (HCAP) have yet to be established. I-ROAD is the prognostic guideline of the Japanese Respiratory Society for hospital-acquired pneumonia (HAP). This study compared available prognostic guidelines to determine the usefulness of I-ROAD as a prognostic tool for patients with HCAP.
We conducted a retrospective review of all patients with pneumonia admitted to Kameda Medical Center, Japan, from January 2006 to September 2009. Patients were categorised into two groups, namely those with community acquired pneumonia (CAP) and those with HCAP. We compared the baseline characteristics, laboratory findings, identified pathogens, antibiotic regimens, clinical outcomes, pneumonic severity and prognostic accuracy of each guideline between the two patient groups. The severity of each disease was assessed on admission using the A-DROP, CURB-65, PSI and I-ROAD guidelines.
Of the 302 patients evaluated, 228 (75.5%) were diagnosed with CAP and 74 (24.5%) with HCAP. Patients with HCAP were older and had a higher performance status than patients with CAP. The mortality rate in the CAP group tended to rise with increasing severity scores of prognostic guidelines. Although the severity scores of all prognostic guidelines could predict 30-day mortality in patients with CAP, I-ROAD exhibited a higher discriminatory power for patients with HCAP based on analysis of receiver-operating characteristic curves.
I-ROAD could be more accurate than other prognostic guidelines for evaluating the severity of HCAP.
预测肺炎患者的预后能力至关重要，尤其是在制定治疗方案和护理地点决策时。然而，医疗保健相关肺炎（HCAP）的预后指南尚未确立。I-ROAD是日本呼吸学会针对医院获得性肺炎（HAP）的预后指南。本研究比较了现有的预后指南，以确定I-ROAD作为HCAP患者预后工具的有用性。
我们对2006年1月至2009年9月在日本镰田医疗中心住院的所有肺炎患者进行了回顾性研究。患者分为两组，即社区获得性肺炎（CAP）患者和HCAP患者。我们比较了两组患者的基线特征、实验室检查结果、鉴定出的病原体、抗生素治疗方案、临床结局、肺炎严重程度以及各指南的预后准确性。每种疾病的严重程度在入院时使用A-DROP、CURB-65、PSI和I-ROAD指南进行评估。
在评估的302例患者中，228例（75.5%）被诊断为CAP，74例（24.5%）被诊断为HCAP。HCAP患者比CAP患者年龄更大，体能状态更高。CAP组的死亡率倾向于随着预后指南严重程度评分的增加而上升。尽管所有预后指南的严重程度评分都可以预测CAP患者的30天死亡率，但根据受试者工作特征曲线分析表明，I-ROAD对HCAP患者具有更高的鉴别力。
在评估HCAP严重程度方面，I-ROAD可能比其他预后指南更准确。
