Vicco Miguel Hernan, Ferini Franco, Rodeles Luz, Scholtus Patricia, Long Ana Karina, Musacchio Héctor Mario
Internal Medicine Service, Hospital José Bernardo Iturraspe, Santa Fe, Argentina.
Rev Assoc Med Bras (1992). 2015 Mar-Apr;61(2):144-9. doi: 10.1590/1806-9282.61.02.144.
several scores were developed in order to improve the determination of community acquired pneumonia (CAP) severity and its management, mainly CURB-65 and SACP score. However, none of them were evaluated for risk assessment of in-hospital mortality, particularly in individuals who were non-immunosuppressed and/or without any comorbidity. In this regard, the present study was carried out.
we performed a cross-sectional study in 272 immunocompetent patients without comorbidities and with a diagnosis of CAP. Performance of CURB- 65 and SCAP scores in predicting in-hospital mortality was evaluated. Also, variables related to death were assessed. Furthermore, in order to design a model of in-hospital mortality prediction, sampled individuals were randomly divided in two groups. The association of the variables with mortality was weighed and, by multiple binary regression, a model was constructed in one of the subgroups. Then, it was validated in the other subgroup.
both scores yielded a fair strength of agreement, and CURB-65 showed a better performance in predicting in-hospital mortality. In our casuistry, age, white blood cell counts, serum urea and diastolic blood pressure were related to death. The model constructed with these variables showed a good performance in predicting in-hospital mortality; moreover, only one patient with fatal outcome was not correctly classified in the group where the model was constructed and in the group where it was validated.
our findings suggest that a simple model that uses only 4 variables, which are easily accessible and interpretable, can identify seriously ill patients with CAP.
为了改进社区获得性肺炎（CAP）严重程度的判定及其管理，已开发了多种评分系统，主要是CURB - 65和SACP评分。然而，这些评分系统均未针对院内死亡风险评估进行评估，尤其是在非免疫抑制和/或无任何合并症的个体中。鉴于此，开展了本研究。
我们对272例无合并症且诊断为CAP的免疫功能正常患者进行了横断面研究。评估了CURB - 65和SCAP评分在预测院内死亡方面的表现。此外，还评估了与死亡相关的变量。此外，为了设计一个院内死亡预测模型，将抽样个体随机分为两组。对变量与死亡率的关联进行加权，并通过多元二元回归在其中一个亚组中构建模型。然后，在另一个亚组中进行验证。
两种评分系统的一致性强度一般，且CURB - 65在预测院内死亡方面表现更好。在我们的病例中，年龄、白细胞计数、血清尿素和舒张压与死亡有关。用这些变量构建的模型在预测院内死亡方面表现良好；此外，在构建模型的组和验证模型的组中，只有1例死亡患者未被正确分类。
我们的研究结果表明，一个仅使用4个易于获取和解释的变量的简单模型可以识别患有CAP的重症患者。
