Consorci Hospital General Universitari de València, València, Spain.
Universitat de València, València, Spain.
J Gen Intern Med. 2018 Apr;33(4):437-444. doi: 10.1007/s11606-017-4267-8. Epub 2018 Jan 4.
The baseline health status may be a determinant of interest in the evolution of pneumonia.
Our objective was to assess the predictive ability of community-acquired pneumonia (CAP) mortality by combining the Barthel Index (BI) and Pneumonia Severity Index (PSI) in patients aged ≥ 65 years.
DESIGN, PATIENTS AND MAIN MEASURES: In this prospective, observational, multicenter analysis of comorbidities, the clinical data, additional examinations and severity of CAP were measured by the PSI and functional status by the BI. Two multivariable models were generated: Model 1 including the PSI and BI and model 2 with PSI plus BI stratified categorically.
The total population was 1919 patients, of whom 61% had severe pneumonia (PSI IV-V) and 40.4% had some degree of dependence (BI ≤ 90 points). Mortality in the PSI V-IV group was 12.5%. Some degree of dependence was associated with increased mortality in both the mild (7.2% vs. 3.2%; p = 0.016) and severe (14% vs. 3.3%; p < 0.001) pneumonia groups. The combination of PSI IV-V and BI ≤ 90 was the greatest risk factor for mortality (aOR 4.17; 95% CI 2.48 to 7.02) in our series.
The use of a bimodal model to assess CAP mortality (PSI + BI) provides more accurate prognostic information than the use of each index separately.
基础健康状况可能是肺炎演变的一个决定因素。
我们的目的是评估 65 岁以上患者社区获得性肺炎（CAP）死亡率的预测能力，方法是结合巴氏指数（BI）和肺炎严重指数（PSI）。
设计、患者和主要措施：在这项针对合并症的前瞻性、观察性、多中心分析中，通过 PSI 测量临床数据、附加检查和 CAP 的严重程度，通过 BI 测量功能状态。生成了两个多变量模型：模型 1 包括 PSI 和 BI，模型 2 为 PSI 加 BI 分类分层。
总人群为 1919 例患者，其中 61%患有严重肺炎（PSI IV-V），40.4%存在某种程度的依赖（BI ≤ 90 分）。PSI V-IV 组的死亡率为 12.5%。在轻度（7.2%比 3.2%；p = 0.016）和重度肺炎组（14%比 3.3%；p < 0.001）中，某种程度的依赖与死亡率增加相关。PSI IV-V 和 BI ≤ 90 的组合是我们系列中死亡率的最大危险因素（OR 4.17；95%CI 2.48 至 7.02）。
使用双峰模型评估 CAP 死亡率（PSI + BI）比单独使用每个指标提供更准确的预后信息。
