Universidad de La Sabana, Chía, Cundinamarca, Colombia.
Clínica Universidad de La Sabana, Chía, Cundinamarca, Colombia.
Can Respir J. 2022 Jun 3;2022:4493777. doi: 10.1155/2022/4493777. eCollection 2022.
Community-acquired pneumonia (CAP) is a common cause of morbidity and mortality due to misdiagnosis and inappropriate treatment approaches.
To assess the performance of the CORB score in subjects with CAP for predicting in-hospital mortality, death within 30 days of admission, and requirement for invasive mechanical ventilation (IMV) and vasopressor support.
A retrospective, cohort study with diagnostic test analysis of CORB and CURB-65 scores in subjects with CAP according to ATS criteria was undertaken. An alternative CORB score was estimated by replacing SpO ≤90% by the SpO/FiO ratio. Crude and adjusted odd ratios (AOR) were calculated for each variable. The area under the receiver operating characteristics curve (AUROC) was constructed for each score, and outcomes were analyzed. AUROCs were compared with the DeLong test, considering a value <0,05 statistically significant.
From 1,811 subjects who entered the analysis, 15.1% (273/1,811) died in hospital, 8.78% required IMV (159/1,811), and 9.77% (177/1,811) needed vasopressor support. CORB had an AUROC of 0,660 (95% CI: 0,623-0,697) for in-hospital mortality; an AUROC of 0,657 (95% CI: 0,621-0,692) for 30-day mortality; an AUROC of 0,637 (CI 95%: 0,589-0,685) for IMV requirement; and an AUROC of 0,635 (95% CI: 0,589-0,681) for vasopressor support. CORB performance increases when the SpO/FiO ratio <300 is used as oxygenation criterion in the prediction of requirement for IMV and vasopressor support, with AUROC of 0,700 (95% CI: 0,654-0,746; < 0.001) and AUROC of 0,702 (95% CI: 0,66-0,745; < 0.001), respectively. CURB-65 score presents an in-hospital mortality AUROC of 0,727 (95% CI: 0,695-0,759) and 30-day mortality AUROC of 0,726 (95% CI: 0,695-0,756).
CORB score has a good performance in predicting the need for IMV and vasopressor support in CAP patients. This performance improves when the SpO/FiO ratio <300 is used instead of the SpO2 ≤90% as the oxygenation parameter. CURB-65 score is superior in the prediction of mortality.
社区获得性肺炎（CAP）是发病率和死亡率较高的疾病，其主要原因是诊断错误和治疗不当。
评估 CORB 评分在 CAP 患者中预测住院死亡率、入院后 30 天内死亡率以及需要有创机械通气（IMV）和血管加压支持的能力。
采用回顾性队列研究，根据 ATS 标准对符合 CAP 诊断标准的患者进行 CORB 和 CURB-65 评分的诊断测试分析。通过用 SpO/FiO 比值替代 SpO ≤90%来估计替代的 CORB 评分。计算每个变量的粗比值比（OR）和调整比值比（AOR）。为每个评分绘制受试者工作特征曲线（ROC）的曲线下面积（AUROC），并进行分析。采用 DeLong 检验比较 AUROCs，以 < 0.05 为统计学显著差异。
在纳入分析的 1811 例患者中，15.1%（273/1811）在住院期间死亡，8.78%（159/1811）需要 IMV，9.77%（177/1811）需要血管加压支持。CORB 评分对住院死亡率的 AUROC 为 0.660（95%CI：0.623-0.697）；对 30 天死亡率的 AUROC 为 0.657（95%CI：0.621-0.692）；对 IMV 需求的 AUROC 为 0.637（95%CI：0.589-0.685）；对血管加压支持的 AUROC 为 0.635（95%CI：0.589-0.681）。当将 SpO/FiO 比值<300 用作预测 IMV 和血管加压支持需求的氧合标准时，CORB 评分的性能会提高，其 AUROC 分别为 0.700（95%CI：0.654-0.746； < 0.001）和 0.702（95%CI：0.66-0.745； < 0.001）。CURB-65 评分对住院死亡率的 AUROC 为 0.727（95%CI：0.695-0.759），30 天死亡率的 AUROC 为 0.726（95%CI：0.695-0.756）。
CORB 评分在预测 CAP 患者需要 IMV 和血管加压支持方面具有良好的性能。当将 SpO/FiO 比值<300 用作预测 IMV 和血管加压支持需求的氧合参数时，其性能会提高。CURB-65 评分在预测死亡率方面表现更佳。
