社区获得性肺炎老年患者中临床评分与基于炎症或营养的评分的比较预后准确性

Comparative Prognostic Accuracy of Clinical and Inflammation- or Nutrition-Based Scores in Older Adults with Community-Acquired Pneumonia.

作者信息

Eksioglu Merve, Azapoglu Kaymak Burcu, Unal Akoglu Ebru, Akyıldız Selman Faruk, Sivil Ramazan, Cimilli Ozturk Tuba

机构信息

Department of Emergency Medicine, University of Health Sciences, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey.

Department of Emergency Medicine, University of Health Sciences, Antalya Education and Research Hospital, Antalya, Turkey.

出版信息

Int J Gen Med. 2025 Aug 27;18:4811-4824. doi: 10.2147/IJGM.S540730. eCollection 2025.

DOI:10.2147/IJGM.S540730

PMID:40894445

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12399091/

Abstract

PURPOSE

This study aimed to assess the prognostic accuracy of the Glasgow Prognostic Score (GPS), modified Glasgow Prognostic Score (mGPS), and C-reactive protein/albumin ratio (CAR) in predicting 30-day mortality and intensive care unit (ICU) admission compared with the Pneumonia Severity Index (PSI) and CURB-65 in older adults with community-acquired pneumonia (CAP).

PATIENTS AND METHODS

This retrospective, single-center cohort study was conducted in a tertiary emergency department. Patients aged ≥65 years with CAP were included. Exclusion criteria were hospital- or ventilator-associated pneumonia, pneumonia mimics, and immunocompromised status. GPS and mGPS were calculated using CRP >10 mg/L and albumin <35 g/L. ROC and logistic regression analyses were performed.

RESULTS

A total of 349 patients (mean age: 77.96 ± 8.42 years; 52.7% men) were included. The 30-day mortality and ICU admission rates were 19.5% and 27.2%, respectively. For predicting mortality, the GPS showed an AUC of 0.753 (95% CI: 0.690-0.816), sensitivity of 75.0%, specificity of 73.3%, PPV of 43.9%, and NPV of 92.4%. mGPS had an AUC of 0.747 (95% CI: 0.679-0.814), sensitivity 77.9%, specificity 73.3%, PPV 45.2%, and NPV 93.2%. The CAR yielded an AUC of 0.677 (95% CI: 0.604-0.751), sensitivity of 82.4%, specificity of 45.6%, PPV of 29.5%, and NPV of 91.4%. For ICU admission, the AUCs were 0.770 (GPS), 0.757 (mGPS), and 0.676 (CAR). The PSI demonstrated the highest predictive accuracy (AUC: 0.884 for mortality, 0.919 for ICU admission), followed by CURB-65 (AUC: 0.848 and 0.879, respectively). Independent predictors of 30-day mortality included acute confusion, lower PaO/FiO ratio, low systolic blood pressure, reduced hemoglobin levels, and Alzheimer's disease or dementia.

CONCLUSION

The PSI and CURB-65 demonstrated superior prognostic accuracy. GPS and mGPS showed moderate performance, whereas CAR exhibited the lowest overall discriminative ability for both outcomes.

摘要

目的

本研究旨在评估格拉斯哥预后评分（GPS）、改良格拉斯哥预后评分（mGPS）和C反应蛋白/白蛋白比值（CAR）在预测老年社区获得性肺炎（CAP）患者30天死亡率和重症监护病房（ICU）入住率方面的预后准确性，并与肺炎严重程度指数（PSI）和CURB - 65进行比较。

患者与方法

本回顾性单中心队列研究在一家三级急诊科进行。纳入年龄≥65岁的CAP患者。排除标准为医院或呼吸机相关性肺炎、肺炎疑似病例和免疫功能低下状态。使用CRP>10 mg/L和白蛋白<35 g/L计算GPS和mGPS。进行了ROC和逻辑回归分析。

结果

共纳入349例患者（平均年龄：77.96±8.42岁；52.7%为男性）。30天死亡率和ICU入住率分别为19.5%和27.2%。对于预测死亡率，GPS的AUC为0.753（95%CI：0.690 - 0.816），敏感性为75.0%，特异性为73.3%，阳性预测值为43.9%，阴性预测值为92.4%。mGPS的AUC为0.747（95%CI：0.679 - 0.814），敏感性77.9%，特异性73.3%，阳性预测值45.2%，阴性预测值93.2%。CAR的AUC为0.677（95%CI：0.604 - 0.751），敏感性为82.4%，特异性为45.6%，阳性预测值为29.5%，阴性预测值为91.4%。对于ICU入住，GPS的AUC为0.770，mGPS为0.757，CAR为0.676。PSI显示出最高的预测准确性（死亡率AUC：0.884，ICU入住AUC：0.919），其次是CURB - 65（分别为AUC：0.848和0.879）。30天死亡率的独立预测因素包括急性意识模糊、较低的PaO/FiO比值、低收缩压、血红蛋白水平降低以及阿尔茨海默病或痴呆。