Asai Nobuhiro, Watanabe Hiroki, Shiota Arufumi, Kato Hideo, Sakanashi Daisuke, Hagihara Mao, Koizumi Yusuke, Yamagishi Yuka, Suematsu Hiroyuki, Mikamo Hiroshige
Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Aichi, Japan; Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan.
Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan.
J Infect Chemother. 2018 Mar;24(3):228-231. doi: 10.1016/j.jiac.2017.10.004. Epub 2017 Dec 16.
The Japanese Respiratory Society newly updated the prognostic guidelines for pneumonia in 2017. Quick Sequential Organ Failure Assessment (qSOFA) and Sequential Organ Failure Assessment (SOFA) score are used to evaluate the severity of pneumonia and to select the therapy for pneumonia. This is a retrospective study at Aichi Medical University hospital from January to December of 2016 to investigate the accuracy and usefulness of qSOFA and SOFA score in evaluating the severity and prognosis of healthcare-associated pneumonia (HCAP). A total of 81 HCAP patients were enrolled in this study. Both the 30-day and in-hospital mortality were 7.5% (6/81). qSOFA≧2 was in 33/78 patients (42%) and <2 in 45/78 patients (58%), showing a 30-day mortality of 9.1% (3/33) and 6.7% (3/45) (p = 0.45), respectively. Comparing with qSOFA≧2 and < 2 group, HCAP patients with qSOFA≧2 had much higher A-DROP (31. v.s. 2.2, p < 0.001), CURB-65 (2.7 v.s. 1.9, p < 0.001), PSI (133 v.s. 114, p = 0.014), I-ROAD (2.7 v.s. 1.9, p < 0.001) and SOFA scores (3.8 v.s. 2.8, p < 0.001). With respect to the diagnostic value of predictive values for 30-day mortality among HCAP patients, the area under the receiver-operating characteristic curve for SOFA score was 0.930 with a statistical significance (p < 0.001). The SOFA score cutoff value was 4 and had a sensitivity of 20%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 68%. In conclusion, SOFA core could be one of the most useful tools in evaluating the severity of HCAP.
日本呼吸学会于2017年对肺炎预后指南进行了更新。快速序贯器官衰竭评估（qSOFA）和序贯器官衰竭评估（SOFA）评分用于评估肺炎的严重程度并选择肺炎的治疗方法。这是一项在爱知医科大学医院进行的回顾性研究，研究时间为2016年1月至12月，旨在调查qSOFA和SOFA评分在评估医疗相关肺炎（HCAP）严重程度和预后方面的准确性和实用性。本研究共纳入81例HCAP患者。30天和住院死亡率均为7.5%（6/81）。qSOFA≥2的患者有33/78例（42%），＜2的患者有45/78例（58%），其30天死亡率分别为9.1%（3/33）和6.7%（3/45）（p = 0.45）。与qSOFA≥2组和＜2组相比，qSOFA≥2的HCAP患者的A-DROP（31对2.2，p＜0.001）、CURB-65（2.7对1.9，p＜0.001）、PSI（133对114，p = 0.014）、I-ROAD（2.7对1.9，p＜0.001）和SOFA评分（3.8对2.8，p＜0.001）要高得多。关于HCAP患者30天死亡率预测值的诊断价值，SOFA评分的受试者工作特征曲线下面积为0.930，具有统计学意义（p＜0.001）。SOFA评分临界值为4，敏感性为20%，特异性为100%，阳性预测值为100%，阴性预测值为68%。总之，SOFA评分可能是评估HCAP严重程度最有用的工具之一。
