Wen Jia-Ning, Li Nan, Guo Chen-Xia, Shen Ning, He Bei
Department of Respiratory Medicine, Peking University Third Hospital, Beijing 100191, China.
Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing 100191, China.
Chin Med J (Engl). 2020 Dec 3;133(24):2947-2952. doi: 10.1097/CM9.0000000000001252.
Hospital-acquired pneumonia (HAP) is the most common hospital-acquired infection in China with substantial morbidity and mortality. But no specific risk assessment model has been well validated in patients with HAP. The aim of this study was to investigate the published risk assessment models that could potentially be used to predict 30-day mortality in HAP patients in non-surgical departments.
This study was a single-center, retrospective study. In total, 223 patients diagnosed with HAP from 2012 to 2017 were included in this study. Clinical and laboratory data during the initial 24 hours after HAP diagnosis were collected to calculate the pneumonia severity index (PSI); consciousness, urea nitrogen, respiratory rate, blood pressure, and age ≥65 years (CURB-65); Acute Physiology and Chronic Health Evaluation II (APACHE II); Sequential Organ Failure Assessment (SOFA); and Quick Sequential Organ Failure Assessment (qSOFA) scores. The discriminatory power was tested by constructing receiver operating characteristic (ROC) curves, and the areas under the curve (AUCs) were calculated.
The all-cause 30-day mortality rate was 18.4% (41/223). The PSI, CURB-65, SOFA, APACHE II, and qSOFA scores were significantly higher in non-survivors than in survivors (all P < 0.001). The discriminatory abilities of the APACHE II and SOFA scores were better than those of the CURB-65 and qSOFA scores (ROC AUC: APACHE II vs. CURB-65, 0.863 vs. 0.744, Z = 3.055, P = 0.002; APACHE II vs. qSOFA, 0.863 vs. 0.767, Z = 3.017, P = 0.003; SOFA vs. CURB-65, 0.856 vs. 0.744, Z = 2.589, P = 0.010; SOFA vs. qSOFA, 0.856 vs. 0.767, Z = 2.170, P = 0.030). The cut-off values we defined for the SOFA, APACHE II, and qSOFA scores were 4, 14, and 1.
These results suggest that the APACHE II and SOFA scores determined during the initial 24 h after HAP diagnosis may be useful for the prediction of 30-day mortality in HAP patients in non-surgical departments. The qSOFA score may be a simple tool that can be used to quickly identify severe infections.
医院获得性肺炎（HAP）是中国最常见的医院获得性感染，具有较高的发病率和死亡率。但尚无针对HAP患者的特异性风险评估模型得到充分验证。本研究旨在调查已发表的可能用于预测非手术科室HAP患者30天死亡率的风险评估模型。
本研究为单中心回顾性研究。共纳入2012年至2017年诊断为HAP的223例患者。收集HAP诊断后最初24小时内的临床和实验室数据，以计算肺炎严重程度指数（PSI）；意识、尿素氮、呼吸频率、血压和年龄≥65岁（CURB-65）；急性生理与慢性健康状况评估II（APACHE II）；序贯器官衰竭评估（SOFA）；以及快速序贯器官衰竭评估（qSOFA）评分。通过构建受试者工作特征（ROC）曲线测试鉴别能力，并计算曲线下面积（AUC）。
全因30天死亡率为18.4%（41/223）。非幸存者的PSI、CURB-65、SOFA、APACHE II和qSOFA评分显著高于幸存者（均P<0.001）。APACHE II和SOFA评分的鉴别能力优于CURB-65和qSOFA评分（ROC AUC：APACHE II对CURB-65，0.863对0.744，Z=3.0５5，P=0.002；APACHE II对qSOFA，0.863对0.767，Z=3.017，P=0.003；SOFA对CURB-65，0.856对0.744，Z=2.589，P=0.010；SOFA对qSOFA，0.856对0.767，Z=2.170，P=0.030）。我们为SOFA、APACHE II和qSOFA评分定义的临界值分别为4、14和1。
这些结果表明，HAP诊断后最初24小时内确定的APACHE II和SOFA评分可能有助于预测非手术科室HAP患者的30天死亡率。qSOFA评分可能是一种可用于快速识别严重感染的简单工具。
