我们能否在不使用肺炎严重程度指数的情况下识别重症社区获得性肺炎？使用改良qSOFA联合降钙素原。
Can we recognize severe community-acquired pneumonia without pneumonia severity index? Use of modified qSOFA with procalcitonin.
作者信息
Güleç Tolgahan, Yılmaz Sarper, Ak Rohat, Tatlıparmak Ali Cankut, Karcıoğlu Özgür
机构信息
University of Health Sciences, Dept. of Emergency Medicine, Adiyaman Education and Research Hospital, Adiyaman, Turkey.
University of Health Sciences, Dept. of Emergency Medicine, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey.
出版信息
Heliyon. 2023 Sep 9;9(9):e19937. doi: 10.1016/j.heliyon.2023.e19937. eCollection 2023 Sep.
OBJECTIVE
The aim of this study is to analyze the diagnostic value of Quick Sequential Organ Failure Assessment (qSOFA), modified qSOFA, National Early Warning Score (NEWS) and NEWS + Lactate (NEWS + L) scores in the detection of severe community-acquired pneumonia (CAP).
METHODS
This research is a retrospective cohort study. Patients admitted to the Emergency Department (ED) with the diagnosis of CAP were divided into severe and mild pneumonia regarding their Pneumonia Severity Index (PSI) scores. The accuracies of lactate, procalcitonin (PCT) values, NEWS and qSOFA scores, as well as score combinations (NEWS + L and qSOFA + PCT) in predicting patients with severe CAP were analyzed.
RESULTS
Median qSOFA value in the severe CAP group (0 [IQR 0-1]) was found to be higher than median qSOFA value (0 [IQR 0-0]) in the mild CAP group (p < 0.001). The rate of qSOFA positivity (qSOFA ≥ 2) was significantly higher in the severe CAP group (17.1%, n = 21) compared to the mild CAP group (1.3%, n = 1) (p < 0.001). Median qSOFA + PCT for the severe CAP group (2 [IQR 1-2]) was higher than the mild CAP group (1 [IQR 0-1]) (p < 0.001). Mean NEWS score for severe CAP (4.95 ± 3.09) was found to be 1.69 (95% CI 0.92-2.46) higher than mean NEWS score of the mild CAP group (3.26 ± 2.39) (p < 0.001). The severe CAP NEWS + L score (6.97 ± 3.71) was higher than the mild CAP NEWS + L score (4.94 ± 2.48) (p < 0.001). Blood lactate level was not significant in the evaluation of severe CAP (p = 0.221). PCT (AUROC = 0.685 [95% CI 0.610-0.760]; p = 0.038), NEWS score (AUROC = 0.658 95% CI [0.582-0.733]; p < 0.001), qSOFA (AUROC = 0.686) were calculated to have adequate accuracy for the detection of severe CAP. [95% CI 0.613-0.759]; p = 0.037), NEWS + L score (AUROC = 0.665 [95% CI 0.589-0.740]; p = 0.038). The qSOFA + PCT score (AUROC = 0.758 [95% 0.691-0.825]; p = 0.034) was also found to be a highly accurate predictor of severe CAP.
CONCLUSION
In this study, we found a combination of qSOFA and PCT to be the most reliable method of detecting severe CAP.
目的
本研究旨在分析快速序贯器官衰竭评估（qSOFA）、改良qSOFA、国家早期预警评分（NEWS）以及NEWS + 乳酸（NEWS + L）评分在检测重症社区获得性肺炎（CAP）中的诊断价值。
方法
本研究为回顾性队列研究。因CAP诊断入住急诊科（ED）的患者根据肺炎严重指数（PSI）评分分为重症肺炎和轻症肺炎两组。分析乳酸、降钙素原（PCT）值、NEWS和qSOFA评分以及评分组合（NEWS + L和qSOFA + PCT）预测重症CAP患者的准确性。
结果
发现重症CAP组的qSOFA中位数（0 [四分位间距0 - 1]）高于轻症CAP组的qSOFA中位数（0 [四分位间距0 - 0]）（p < 0.001）。重症CAP组的qSOFA阳性率（qSOFA≥2）（17.1%，n = 21）显著高于轻症CAP组（1.3%，n = 1）（p < 0.001）。重症CAP组的qSOFA + PCT中位数（2 [四分位间距1 - 2]）高于轻症CAP组（1 [四分位间距0 - 1]）（p < 0.001）。发现重症CAP的平均NEWS评分（4.95±3.09）比轻症CAP组的平均NEWS评分（3.26±2.39）高1.69（95%可信区间0.92 - 2.46）（p < 0.001）。重症CAP的NEWS + L评分（6.97±3.71）高于轻症CAP的NEWS + L评分（4.94±2.48）（p < 0.001）。血乳酸水平在评估重症CAP时无显著意义（p = 0.221）。计算得出PCT（曲线下面积=0.685 [95%可信区间0.
610 - 0.760]；p = 0.038）、NEWS评分（曲线下面积=0.658 [95%可信区间0.582 - 0.733]；p < 0.001）、qSOFA（曲线下面积=0.686 [95%可信区间
0.613 - 0.759]；p = 0.037）、NEWS + L评分（曲线下面积=0.665 [95%可信区间0.589 - 0.740]；p = 0.038）在检测重症CAP方面具有足够的准确性。qSOFA + PCT评分（曲线下面积=0.758 [95% 0.691 - 0.825]；p = 0.034）也被发现是重症CAP的高度准确预测指标。
结论
在本研究中，我们发现qSOFA和PCT的组合是检测重症CAP最可靠的方法。
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