Universidade Salvador, Salvador, Bahia, Brazil.
Multinational Organization Network Sponsoring Translational and Epidemiological Research Initiative, Fundação José Silveira, Salvador, Brazil.
Clin Infect Dis. 2021 Mar 15;72(6):942-949. doi: 10.1093/cid/ciaa183.
Severity stratification scores developed in intensive care units (ICUs) are used in interventional studies to identify the most critically ill. Studies that evaluate accuracy of these scores in ICU patients admitted with pneumonia are lacking. This study aims to determine performance of severity scores as predictors of mortality in critically ill patients admitted with pneumonia.
Prospective cohort study in a general ICU in Brazil. ICU severity scores (Simplified Acute Physiology Score 3 [SAPS 3] and Sepsis-Related Organ Failure Assessment [qSOFA]), prognostic scores of pneumonia (CURB-65 [confusion, urea, respiratory rate, blood pressure, age] and CRB-65 [confusion, respiratory rate, blood pressure, age]), and clinical and epidemiological variables in the first 6 hours of hospitalization were analyzed.
Two hundred patients were included between 2015 and 2018, with a median age of 81 years (interquartile range, 67-90 years) and female predominance (52%), primarily admitted from the emergency department (65%) with community-acquired pneumonia (CAP, 80.5%). SAPS 3, CURB-65, CRB-65,and qSOFA all exhibited poor performance in predicting mortality. Multivariate regression identified variables independently associated with mortality that were used to develop a novel pneumonia-specific ICU severity score (Pneumonia Shock score) that outperformed SAPS 3, CURB-65, and CRB-65. The Shock score was validated in an external multicenter cohort of critically ill patients admitted with CAP.
We created a parsimonious score that accurately identifies patients with pneumonia at highest risk of ICU death. These findings are critical to accurately stratify patients with severe pneumonia in therapeutic trials that aim to reduce mortality.
在重症监护病房（ICU）中开发的严重程度分层评分用于干预性研究，以确定最危重的患者。缺乏评估这些评分在因肺炎入住 ICU 的患者中的准确性的研究。本研究旨在确定严重程度评分作为预测因肺炎入住 ICU 的危重症患者死亡率的指标的性能。
这是一项在巴西普通 ICU 进行的前瞻性队列研究。分析了入住 ICU 后 6 小时内的 ICU 严重程度评分（简化急性生理学评分 3 分[SAPS 3]和脓毒症相关器官衰竭评估[qSOFA]）、肺炎预后评分（CURB-65[意识障碍、尿素、呼吸频率、血压、年龄]和 CRB-65[意识障碍、呼吸频率、血压、年龄]）、临床和流行病学变量。
2015 年至 2018 年期间共纳入 200 例患者，中位年龄为 81 岁（四分位距，67-90 岁），女性居多（52%），主要从急诊室（65%）入院，社区获得性肺炎（CAP，80.5%）。SAPS 3、CURB-65、CRB-65 和 qSOFA 预测死亡率的表现均不佳。多变量回归确定了与死亡率独立相关的变量，这些变量用于开发一种新的肺炎特异性 ICU 严重程度评分（肺炎休克评分），该评分优于 SAPS 3、CURB-65 和 CRB-65。该休克评分在另一个包含因 CAP 入住 ICU 的危重症患者的多中心外部队列中得到验证。
我们创建了一个简洁的评分，可准确识别肺炎患者中 ICU 死亡风险最高的患者。这些发现对于在旨在降低死亡率的治疗试验中准确分层严重肺炎患者至关重要。
