Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.
Department of General Surgery, Surgical Specialties and Organ Transplantation "Paride Stefanini", Sapienza University of Rome, Rome, Italy.
Infection. 2024 Aug;52(4):1539-1546. doi: 10.1007/s15010-024-02286-x. Epub 2024 May 3.
Patients hospitalized for community-acquired pneumonia (CAP) may have a higher risk of new-onset atrial fibrillation (NOAF). The CHEST score was developed to evaluate the NOAF risk in the general population. Data on the value of the CHEST score in acute patients admitted with CAP are lacking. We want to establish the predictive value of CHEST score for NOAF in patients with CAP.
Patients with CAP enrolled in the SIXTUS cohort were enrolled. CHEST score was calculated at baseline. In-hospital NOAF was recorded. Receiver-operating Characteristic (ROC) curve and multivariable Cox proportional hazard regression analysis were performed.
We enrolled 473 patients (36% women, mean age 70.6 ± 16.5 years), and 54 NOAF occurred. Patients with NOAF were elderly, more frequently affected by hypertension, heart failure, previous stroke/transient ischemic attack, peripheral artery disease and hyperthyroidism. NOAF patients had also higher CURB-65, PSI class and CHADS-VASc score. The C-index of CHEST score for NOAF was 0.747 (95% confidence interval [95%CI] 0.705-0.786), higher compared to CURB-65 (0.611, 95%CI 0.566-0.655, p = 0.0016), PSI (0.665, 95%CI 0.621-0.708, p = 0.0199) and CHADS-VASc score (0.696, 95%CI 0.652-0.737, p = 0.0762). The best combination of sensitivity (67%) and specificity (70%) was observed with a CHEST score ≥ 4. This result was confirmed by the multivariable Cox analysis (Hazard Ratio [HR] for CHEST score ≥ 4 was 10.7, 95%CI 2.0-57.9; p = 0.006), independently from the severity of pneumonia.
The CHEST score was a useful predictive tool to identify patients at higher risk for NOAF during hospitalization for CAP.
www.
gov (NCT01773863).
因社区获得性肺炎（CAP）住院的患者可能有更高的新发心房颤动（NOAF）风险。CHEST 评分旨在评估一般人群中的 NOAF 风险。有关 CHEST 评分在急性 CAP 患者中的应用价值的数据尚缺乏。我们旨在确定 CHEST 评分在 CAP 患者中的预测价值。
我们招募了 SIXTUS 队列中的 CAP 患者。在基线时计算 CHEST 评分。记录住院期间的 NOAF。进行了受试者工作特征（ROC）曲线和多变量 Cox 比例风险回归分析。
我们共纳入了 473 名患者（36%为女性，平均年龄 70.6±16.5 岁），发生了 54 例 NOAF。NOAF 患者年龄较大，更常患有高血压、心力衰竭、既往卒中/短暂性脑缺血发作、外周动脉疾病和甲状腺功能亢进。NOAF 患者的 CURB-65、PSI 分级和 CHADS-VASc 评分也更高。CHEST 评分对 NOAF 的 C 指数为 0.747（95%置信区间[95%CI]为 0.705-0.786），高于 CURB-65（0.611，95%CI 为 0.566-0.655，p=0.0016）、PSI（0.665，95%CI 为 0.621-0.708，p=0.0199）和 CHADS-VASc 评分（0.696，95%CI 为 0.652-0.737，p=0.0762）。CHEST 评分≥4 时观察到灵敏度（67%）和特异性（70%）的最佳组合。多变量 Cox 分析（CHEST 评分≥4 的 HR 为 10.7，95%CI 为 2.0-57.9；p=0.006）证实了这一结果，且独立于肺炎的严重程度。
CHEST 评分是一种有用的预测工具，可用于识别 CAP 住院期间发生 NOAF 的高危患者。
www.（NCT01773863）。
