一种预测重症社区获得性肺炎患者医院死亡率的新方法。

A new method to predict hospital mortality in severe community acquired pneumonia.

作者信息

Wang Xin, Jiao Jianlong, Wei Rongwei, Feng Yongli, Ma Xiuqin, Li Yuan, Du Yue

机构信息

Key Laboratory of Hormones and Development (Ministry of Health), Tianjin Key Laboratory of Metabolic Diseases, China; Tianjin Metabolic Diseases Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China; Department of General Surgery, The Fourth Center Hospital, Tianjin, China; Center for Pulmonary Disease, Division of ICU, The Fourth Center Hospital, Tianjin, China.

Department of General Surgery, The Fourth Center Hospital, Tianjin, China.

出版信息

Eur J Intern Med. 2017 May;40:56-63. doi: 10.1016/j.ejim.2017.02.013. Epub 2017 Mar 17.

DOI:10.1016/j.ejim.2017.02.013

PMID:28320569

Abstract

BACKGROUND & AIMS: The aim of this study is to develop a new method that is able to accurately predict the 28day hospital mortality in patients with severe community acquired pneumonia (SCAP) at an early stage.

METHODS

We selected 37,348 SCAP patients in ICU from 173 hospitals during 2011.1-2013.12. The predictive factors for 28day hospital mortality were evaluated retrospectively. All cases underwent intensive care, blood routine, blood biochemical tests and arterial blood gas analysis. Under the Classification and Regression Tree (CART) analysis, a new clinical scoring system was developed for early prediction in SCAP patients. The receiver-operating characteristic (ROC) curve was plotted to calculate the area under the receiver operating characteristic curve (AUC).

RESULTS

A novel clinical model named CLCGH scoring system, including Serum creatinine (Cr) >259.5μmol/L, leukocyte (WBC)>17.35×10/L, C-reactive protein (CRP)>189.4μg/mL, GCS≤9 and serum HCO≤17.65mmol/L, was carried out and each index was an independent factor for hospital mortality in SCAP. In validation cohort, the AUC of the new scoring system was 0.889 for prediction of hospital mortality, which was similar to SOFA score 0.877, APACHEII score 0.864, and was better than the PSI score 0.761 and CURB-65 score 0.767.

CONCLUSIONS

The new scoring system CLCGH is an efficient, accurate and objective method to predicate the early hospital mortality among SCAP patients.

摘要

背景与目的

本研究旨在开发一种新方法，能够在早期准确预测重症社区获得性肺炎（SCAP）患者的28天医院死亡率。

方法

我们选取了2011年1月至2013年12月期间173家医院重症监护病房的37348例SCAP患者。回顾性评估28天医院死亡率的预测因素。所有病例均接受重症监护、血常规、血液生化检查和动脉血气分析。在分类回归树（CART）分析的基础上，开发了一种新的临床评分系统用于SCAP患者的早期预测。绘制受试者工作特征（ROC）曲线以计算受试者工作特征曲线下面积（AUC）。

结果

建立了一种名为CLCGH评分系统的新型临床模型，包括血清肌酐（Cr）>259.5μmol/L、白细胞（WBC）>17.35×10/L、C反应蛋白（CRP）>189.4μg/mL、格拉斯哥昏迷量表（GCS）≤9和血清碳酸氢根（HCO）≤17.65mmol/L，每个指标都是SCAP患者医院死亡率的独立因素。在验证队列中，新评分系统预测医院死亡率的AUC为0.889，与序贯器官衰竭评估（SOFA）评分0.877、急性生理与慢性健康状况评分系统II（APACHEII）评分0.864相似，且优于肺炎严重指数（PSI）评分0.761和CURB-65评分0.767。