Li Hai-Yan, Guo Qi, Song Wei-Dong, Zhou Yi-Ping, Li Ming, Chen Xiao-Ke, Liu Hui, Peng Hong-Lin, Yu Hai-Qiong, Chen Xia, Liu Nian, Lü Zhong-Dong, Liang Li-Hua, Zhao Qing-Zhou, Jiang Mei
From the Department of Primary Care, Affiliated Futian Hospital, Guangdong Medical College (HYL); Department of Respiratory Medicine, Affiliated Futian Hospital, Guangdong Medical College (QG, YPZ, ML, XKC, HL, HLP, HQY, XC, NL); Department of Respiratory Medicine, Affiliated Shenzhen Hospital, Peking University (WDS, ZDL); Department of Radiology, Affiliated Futian Hospital, Guangdong Medical College, Shenzhen (LHL, QZZ); and Guangzhou Institute of Respiratory Diseases (State Key Laboratory of Respiratory Diseases), First Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China(MJ).
Medicine (Baltimore). 2015 Sep;94(36):e1474. doi: 10.1097/MD.0000000000001474.
It is not clear whether the IDSA/ATS minor criteria for severe community-acquired pneumonia (CAP) could be simplified or even be modified to orchestrate improvements in predicting mortality.A retrospective cohort study of 1230 CAP patients was performed to simplify and to modify the scoring system by excluding 4 noncontributory or infrequent variables (leukopenia, hypothermia, hypotension, and thrombocytopenia) and by excluding these variables and then adding age ≥65 years, respectively. The simplification and modification were tested against a prospective 2-center validation cohort of 1409 adults with CAP.The increasing numbers of IDSA/ATS, simplified, and modified minor criteria present in the retrospective cohort were positively associated with the mortality, showing significant increased odds ratios for mortality of 2.711, 4.095, and 3.755, respectively. The validation cohort confirmed a similar pattern. The sensitivity, specificity, positive predictive value, and Youden index of modified minor criteria for mortality prediction were the best pattern in the retrospective cohort. High values of corresponding indices were confirmed in the validation cohort. The highest accuracy of the modified version for predicting mortality in the retrospective cohort was illustrated by the highest area under the receiver operating characteristic curve of 0.925 (descending order: modified, simplified, and IDSA/ATS minor criteria). The validation cohort confirmed a similar paradigm.The IDSA/ATS minor criteria could be simplified to 5 variables and then be modified to orchestrate improvements in predicting mortality in CAP patients. The modified version best predicted mortality. These were more suitable for clinic and emergency department.
目前尚不清楚美国感染病学会（IDSA）/美国胸科学会（ATS）制定的重症社区获得性肺炎（CAP）次要标准是否可以简化甚至修改，以改善死亡率预测。对1230例CAP患者进行了一项回顾性队列研究，通过排除4个无贡献或不常见的变量（白细胞减少、体温过低、低血压和血小板减少）来简化和修改评分系统，然后分别排除这些变量并加入年龄≥65岁。针对一个由1409例成年CAP患者组成的前瞻性双中心验证队列，对简化和修改后的标准进行了测试。回顾性队列中存在的IDSA/ATS次要标准数量增加、简化标准数量增加和修改后标准数量增加均与死亡率呈正相关，死亡率的优势比分别显著增加至2.711、4.095和3.755。验证队列证实了类似的模式。回顾性队列中，修改后次要标准预测死亡率的敏感性、特异性、阳性预测值和尤登指数表现最佳。验证队列中相应指标的高值也得到了证实。回顾性队列中，修改版预测死亡率的准确性最高，其受试者工作特征曲线下面积为0.925（降序排列：修改后标准、简化标准和IDSA/ATS次要标准）。验证队列证实了类似的模式。IDSA/ATS次要标准可简化为5个变量，然后进行修改以改善CAP患者死亡率的预测。修改版对死亡率的预测效果最佳。这些标准更适用于临床和急诊科。
