Kim Min Woo, Lim Jee Yong, Oh Sang Hoon
a Department of Emergency Medicine, College of Medicine , The Catholic University of Korea , Seoul , South Korea.
Scand J Clin Lab Invest. 2017 Nov;77(7):486-492. doi: 10.1080/00365513.2017.1344298. Epub 2017 Jul 5.
We evaluated the predictive value of serum biomarkers and various clinical risk scales for the 28-day mortality of community-acquired pneumonia (CAP). Serum biomarkers including procalcitonin (PCT) and C-reactive protein (CRP) were evaluated in the emergency department. Scores for the pneumonia severity index (PSI); CURB65 (confusion, urea, respiration, blood pressure; age >65 years); Infectious Disease Society of America (IDSA) and American Thoracic Society (ATS) guidelines for severe CAP; Acute Physiology, Chronic Health Evaluation (APACHE) II; Sequential Organ Failure Assessment (SOFA); and quick SOFA (qSOFA) were calculated. Receiver-operating characteristic curves for 28-day mortality were calculated for each predictor using cut-off values, and we applied logistic regression models and area under the curve (AUC) analysis to compare the performance of predictors. Of the 125 enrolled patients, 13 died within 28 days. The AUCs of the PCT and CRP were 0.83 and 0.77, respectively. Using a PCT level >5.6 μg/L as the cut-off, the sensitivity and specificity for mortality were 76.9% and 90.2%, respectively. The three pneumonia severity scales showed an AUC of 0.86 (PSI), 0.87 (IDSA/ATS) and 0.77 (CURB65). The AUCs of the APACHE II, SOFA and qSOFA scores were 0.85, 0.83 and 0.81, respectively. The models combining CRP and/or PCT with PSI or the IDSA/ATS guidelines demonstrated superior performance to those of either PSI or the IDAS/ATS guidelines alone. In conclusion, serum PCT is a reliable single predictor for short-term mortality. Inclusion of CRP and/or PCT could significantly improve the performance of the PSI and IDAS/ATS guidelines.
我们评估了血清生物标志物和各种临床风险量表对社区获得性肺炎（CAP）28天死亡率的预测价值。在急诊科评估了包括降钙素原（PCT）和C反应蛋白（CRP）在内的血清生物标志物。计算了肺炎严重程度指数（PSI）、CURB65（意识模糊、尿素、呼吸、血压；年龄>65岁）、美国感染病学会（IDSA）和美国胸科学会（ATS）关于重症CAP的指南、急性生理与慢性健康状况评估（APACHE）II、序贯器官衰竭评估（SOFA）以及快速SOFA（qSOFA）的评分。使用临界值为每个预测指标计算28天死亡率的受试者工作特征曲线，并应用逻辑回归模型和曲线下面积（AUC）分析来比较各预测指标的性能。在125名入组患者中，13人在28天内死亡。PCT和CRP的AUC分别为0.83和0.77。以PCT水平>5.6μg/L作为临界值，死亡率的敏感性和特异性分别为76.9%和90.2%。三种肺炎严重程度量表的AUC分别为0.86（PSI）、0.87（IDSA/ATS）和0.77（CURB65）。APACHE II、SOFA和qSOFA评分的AUC分别为0.85、0.83和0.81。将CRP和/或PCT与PSI或IDSA/ATS指南相结合的模型表现优于单独的PSI或IDAS/ATS指南。总之，血清PCT是短期死亡率的可靠单一预测指标。纳入CRP和/或PCT可显著提高PSI和IDAS/ATS指南的性能。
