University Clinic for Infectious Diseases, Faculty of Medicine, University of Ss Cyril and Methodius, Bul. Majka Tereza br 17, 1000 Skopje, North Macedonia.
Institute of Preclinical and Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Ss Cyril and Methodius, ul. 50ta Divizija 6, 1000 Skopje, Republic of North Macedonia.
Rom J Intern Med. 2021 Nov 20;59(4):394-402. doi: 10.2478/rjim-2021-0025. Print 2021 Dec 1.
The aim of this study was to evaluate the ability of severity scoring systems to predict 30-day mortality in patients with severe community-acquired pneumonia. The study included 98 patients aged ≥18 years with community acquired pneumonia hospitalized at the Intensive Care Unit of the University Clinic for Infectious Diseases in Skopje, Republic of North Macedonia, during a 3-year period. We recorded demographic, clinical and common biochemical parameters. Five severity scores were calculated at admission: CURB 65 (Confusion, Urea, Respiratory Rate, Blood pressure, Age ≥65 years), SCAP (Severe Community Acquired Pneumonia score), SAPS II (Simplified Acute Physiology Score), SOFA (Sequential Organ Failure Assessment Score) and MPM (Mortality Prediction Model). Primary outcome variable was 30-day in-hospital mortality. The mean age of the patients was 59.08 ± 15.76 years, predominantly males (68%). The overall 30-day mortality was 52%. Charlson Comorbidity index was increased in non-survivors (3.72 ± 2.33) and was associated with the outcome. All severity indexes had higher values in patients who died, that showed statistical significance between the analysed groups. The areas under curve (AUC) values of the five scores for 30-day mortality were 0.670, 0.732, 0,726, 0.785 and 0.777, respectively. Widely used severity scores accurately detected patients with pneumonia that had increased risk for poor outcome, but none of them individually demonstrated any advantage over the others.
本研究旨在评估严重评分系统预测重症社区获得性肺炎患者 30 天死亡率的能力。该研究纳入了 98 名年龄≥18 岁的社区获得性肺炎患者，这些患者在北马其顿斯科普里大学传染病临床医院的重症监护病房住院治疗，研究时间为 3 年。我们记录了患者的人口统计学、临床和常见生化参数。入院时计算了 5 个严重程度评分：CURB 65（意识障碍、血尿素氮、呼吸频率、血压、年龄≥65 岁）、SCAP（严重社区获得性肺炎评分）、SAPS II（简化急性生理学评分）、SOFA（序贯器官衰竭评估评分）和 MPM（死亡率预测模型）。主要观察终点为 30 天院内死亡率。患者的平均年龄为 59.08±15.76 岁，以男性为主（68%）。总的 30 天死亡率为 52%。非幸存者的 Charlson 合并症指数增加（3.72±2.33），与结局相关。所有严重程度指数在死亡患者中均有更高的值，且在分析组之间有统计学差异。五个评分对 30 天死亡率的曲线下面积（AUC）值分别为 0.670、0.732、0、0.726、0.785 和 0.777。广泛使用的严重程度评分能够准确地检测出患有肺炎且预后不良风险增加的患者，但没有一种评分在个体表现上优于其他评分。
