Fine M J, Singer D E, Hanusa B H, Lave J R, Kapoor W N
Department of Medicine, University of Pittsburgh, Pennsylvania 15261.
Am J Med. 1993 Feb;94(2):153-9. doi: 10.1016/0002-9343(93)90177-q.
Our purpose was to validate a previously developed pneumonia-specific prognostic index in a large, multicenter population.
We developed a pneumonia-specific prognostic index in a prospective, multicenter study of 346 patients with clinical and radiographic evidence of pneumonia admitted to 3 Pittsburgh hospitals (the derivation cohort), and validated the index in 14,199 patients with a principal ICD-9-CM diagnosis of pneumonia admitted to 78 hospitals in the 1989 MedisGroups Comparative Hospital Database (the validation cohort). The prognostic index classified patients into five ordered risk classes based on six predictors of mortality: age greater than 65 years, pleuritic chest pain, a vital sign abnormality, altered mental status, neoplastic disease, and high-risk pneumonia etiology. Each patient in the validation cohort was assigned to a risk class by obtaining values for the index's six predictors in the MedisGroups population. The performance of the prognostic index in the derivation and validation cohorts was assessed by comparing hospital mortality rates within each of the index's five prognostic risk classes.
The hospital mortality rate was 13.0% in the derivation cohort, and 11.1% in the validation cohort (p = 0.26). The agreement in the risk class-specific mortality rates was striking with the exception of class V: in class I, mortality was 0% in the derivation cohort versus 1% in the validation cohort; in class II, 0% versus 1.1%; class III, 10.9% versus 8.6%; class IV, 21.8% versus 26.2%; and class V, 73.7% versus 37.7%. There were no statistically significant differences in mortality rates within the first four risk classes, which represented the vast majority of patients in the derivation (94%) as well as the validation (98%) cohorts.
These data support the generalizability of a pneumonia-specific prognostic index. This index, which performs exceptionally well in classifying low-risk patients, may help physicians identify patients with community-acquired pneumonia who could safely be managed in the ambulatory setting, or if hospitalized, the patients that could be treated with abbreviated inpatient care.
我们的目的是在一个大型多中心人群中验证先前开发的肺炎特异性预后指数。
我们在一项前瞻性多中心研究中开发了肺炎特异性预后指数，该研究纳入了3家匹兹堡医院收治的346例有临床和影像学证据的肺炎患者（推导队列），并在1989年医疗集团比较医院数据库中78家医院收治的14199例主要ICD - 9 - CM诊断为肺炎的患者中验证了该指数（验证队列）。该预后指数根据六个死亡预测因素将患者分为五个有序风险等级：年龄大于65岁、胸膜炎性胸痛、生命体征异常、精神状态改变、肿瘤疾病和高危肺炎病因。通过获取验证队列中每位患者在医疗集团人群中该指数六个预测因素的值，将其分配到一个风险等级。通过比较该指数五个预后风险等级中每个等级的医院死亡率，评估推导队列和验证队列中预后指数的表现。
推导队列的医院死亡率为13.0%，验证队列的医院死亡率为11.1%（p = 0.26）。除V级外，风险等级特异性死亡率的一致性非常显著：在I级中，推导队列的死亡率为0%，验证队列为1%；II级中，分别为0%和1.1%；III级中，分别为10.9%和8.6%；IV级中，分别为21.8%和26.2%；V级中，分别为73.7%和37.7%。在前四个风险等级中死亡率没有统计学显著差异，这四个等级代表了推导队列中绝大多数患者（94%）以及验证队列中绝大多数患者（98%）。
这些数据支持肺炎特异性预后指数的可推广性。该指数在对低风险患者进行分类方面表现出色，可能有助于医生识别可在门诊安全管理的社区获得性肺炎患者，或者如果住院，可接受简化住院治疗的患者。
