Division of Pulmonology, Medical Department I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
Infection. 2020 Apr;48(2):267-274. doi: 10.1007/s15010-020-01391-x. Epub 2020 Feb 1.
Current risk stratification in community-acquired pneumonia (CAP) does not incorporate the dynamic nature of CAP evolution. Study aim was to evaluate the predictive value of early blood pressure (BP) drop and its consideration within the CRB-65 score.
We performed a retrospective cohort study including consecutive adult hospitalized CAP patients 2013-2014 without documented treatment limitations or direct ICU admission. The CRB-65 score was calculated initially and re-calculated including any BP below the threshold (BP drop) within the first 24 h (CRB-65[BP24]). The primary endpoint was need for mechanical ventilation or vasopressors (MVVS) occurring after 24 h. Prognostic values were evaluated by uni- and multivariate and ROC curve analyses.
28/294 patients (9.5%) met the primary endpoint. Only 3 (11%) of them showed an initial BP of < 90 mmHg systolic or ≤ 60 mmHg diastolic, but 21 (75%) developed a BP drop within the first 24 h. 24/178 (13%) with and only 4/116 (3%) without any low BP during the first 24 h needed MVVS (p = 0.004). After multivariate analysis, the predictive value of BP drop was independent of other score parameters and biomarkers (all p < 0.01). In ROC analysis, the new CRB-65(BP24) showed a better prediction than the CRB-65 score (AUC 0.69 vs. 0.62, p = 0.04). 7/13 patients (54%) with MVVS despite an admission CRB-65 of 0 or 1 showed a BP drop.
In the evaluated cohort, BP drop within the first 24 h was significantly associated with more need for MVVS in CAP, and its consideration improved the prognostic value of the CRB-65 score.
目前社区获得性肺炎（CAP）的风险分层并未纳入 CAP 演变的动态性质。本研究旨在评估早期血压（BP）下降的预测价值及其在 CRB-65 评分中的考虑。
我们进行了一项回顾性队列研究，纳入了 2013-2014 年连续住院的 CAP 成年患者，这些患者没有记录治疗受限或直接 ICU 入院。最初计算 CRB-65 评分，并在最初 24 小时内（BP24 内）计算任何低于阈值的 BP 时重新计算 CRB-65 评分（CRB-65[BP24]）。主要终点是 24 小时后需要机械通气或血管加压药（MVVS）。通过单变量和多变量以及 ROC 曲线分析评估预后价值。
28/294 例患者（9.5%）达到主要终点。只有 3 例（11%）最初的收缩压<90mmHg 或舒张压≤60mmHg，但 21 例（75%）在最初 24 小时内出现血压下降。24/178 例（13%）有且只有 4/116 例（3%）在最初 24 小时内没有任何低血压需要 MVVS（p=0.004）。多变量分析后，BP 下降的预测价值独立于其他评分参数和生物标志物（均 p<0.01）。在 ROC 分析中，新的 CRB-65（BP24）比 CRB-65 评分具有更好的预测能力（AUC 0.69 与 0.62，p=0.04）。尽管入院时 CRB-65 为 0 或 1，但 13 例（54%）需要 MVVS 的患者中仍有 7 例出现血压下降。
在评估的队列中，最初 24 小时内的 BP 下降与 CAP 中更需要 MVVS 显著相关，并且考虑其因素可提高 CRB-65 评分的预后价值。
