社区获得性肺炎：急诊室三种死亡率预测评分的比较。
Community-acquired pneumonia: comparison of three mortality prediction scores in the emergency department.
机构信息
Universidad de Antioquia; GRAEPIC - Clinical Epidemiology Academic Group (Grupo Académico de Epidemiología Clínica); Medellín, Colombia.
Universidad de Antioquia, School of Medicine, Department of Internal Medicine, Medellín, Colombia.
出版信息
Colomb Med (Cali). 2021 Oct 23;52(4):e2044287. doi: 10.25100/cm.v52i4.4287. eCollection 2021 Oct-Dec.
BACKGROUND
qSOFA is a score to identify patients with suspected infection and risk of complications. Its criteria are like those evaluated in prognostic scores for pneumonia (CRB-65 - CURB-65), but it is not clear which is best for predicting mortality and admission to the ICU.
OBJECTIVE
Compare three scores (CURB-65, CRB-65 and qSOFA) to determine the best tool to identify emergency department patients with pneumonia at increased risk of mortality or intensive care unit (ICU) admission.
METHODS
Secondary analysis of three prospective cohorts of patients hospitalized with diagnosis of pneumonia in five Colombian hospitals. Validation and comparison of the score´s accuracies were performed by means of discrimination and calibration measures.
RESULTS
Cohorts 1, 2 and 3 included 158, 745 and 207 patients, with mortality rates of 32.3%, 17.2% and 18.4%, and admission to ICU was required for 52.5%, 43.5% and 25.6%, respectively. The best AUC-ROC for mortality was for CURB-65 in cohort 3 (AUC-ROC=0.67). The calibration was adequate (p>0.05) for the three scores.
CONCLUSIONS
None of these scores proved to be an appropriate predictor for mortality and admission to the ICU. Furthermore, the CRB 65 exhibited the lowest discriminative ability.
背景
qSOFA 是一种用于识别疑似感染患者和并发症风险的评分系统。其标准类似于用于评估肺炎预后评分的标准（CRB-65-CURB-65），但尚不清楚哪种评分系统最适合预测死亡率和入住 ICU。
目的
比较三种评分（CURB-65、CRB-65 和 qSOFA），以确定用于识别急诊科肺炎患者死亡风险或入住 ICU 风险增加的最佳工具。
方法
对在五家哥伦比亚医院住院诊断为肺炎的三个前瞻性队列进行二次分析。通过区分度和校准措施对评分的准确性进行验证和比较。
结果
队列 1、2 和 3分别纳入了 158、745 和 207 名患者，死亡率分别为 32.3%、17.2%和 18.4%，需要入住 ICU 的患者比例分别为 52.5%、43.5%和 25.6%。队列 3 中 CURB-65 对死亡率的最佳 AUC-ROC 为 0.67。对于三种评分，校准都是足够的（p＞0.05）。
结论
这些评分均不能准确预测死亡率和入住 ICU。此外，CRB 65 的区分能力最低。
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