白蛋白对重症社区获得性肺炎预后的评估价值
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摘要
目的:探讨白蛋白(ALB)预测重症社区获得性肺炎患者预后的价值。方法:收集2014-01—2018-08期间因重症社区获得性肺炎收治入我院急诊科的患者149例。根据预后分为存活组(83例)与死亡组(66例),回顾性分析两组间的临床资料。结果:死亡组年龄、白细胞计数、中性粒细胞计数、中性粒细胞/淋巴细胞比率(NLR)、肌酐、PSI评分显著高于存活组,血红蛋白、ALB显著低于存活组,差异有统计学意义(P<0.05)。多因素Logistic回归分析示ALB是重症社区获得性肺炎预后不良的独立危险因素(P <0.05),其曲线下面积为0.711,与PSI评分联合后曲线下面积提高至0.793,曲线下面积均差异有统计学意义(P<0.01)。结论:ALB是影响重症社区获得性肺炎患者预后的独立危险因素,并可以提高PSI评分预测病死率的效能。
Objective:To explore the predictive value of albumin on prognosis of patients with severe community-acquired pneumonia.Method:The study included 149 patients admitted to our hospital between January 2014 and August 2018 with severe community-acquired pneumonia.The patients were divided into the survival group(83 cases)and the death group(66 cases)according to the prognosis.The clinical data between the two groups were analyzed retrospectively.Result:The age,white blood cell counts,neutrophil counts,neutrophil to lymphocyte ratio(NLR),creatinine,PSI were higher in death group,while hemoglobin and albumin were lower than those in the survival group,with statistically significant differences(P<0.05).Multivariate Logistic regression analysis showed that ALB was an independent factor for poor prognosis of severe community-acquired pneumonia(P<0.05),and its area under the curves was 0.711,which was increased to 0.793 when combined with PSI,and all had significant significance(P<0.01).Conclusion:ALB was an independent risk factor affecting the prognosis of patients with severe community-acquired pneumonia,and could increased prognostic performance when combined with the PSI score.
Objective:To explore the predictive value of albumin on prognosis of patients with severe community-acquired pneumonia.Method:The study included 149 patients admitted to our hospital between January 2014 and August 2018 with severe community-acquired pneumonia.The patients were divided into the survival group(83 cases)and the death group(66 cases)according to the prognosis.The clinical data between the two groups were analyzed retrospectively.Result:The age,white blood cell counts,neutrophil counts,neutrophil to lymphocyte ratio(NLR),creatinine,PSI were higher in death group,while hemoglobin and albumin were lower than those in the survival group,with statistically significant differences(P<0.05).Multivariate Logistic regression analysis showed that ALB was an independent factor for poor prognosis of severe community-acquired pneumonia(P<0.05),and its area under the curves was 0.711,which was increased to 0.793 when combined with PSI,and all had significant significance(P<0.01).Conclusion:ALB was an independent risk factor affecting the prognosis of patients with severe community-acquired pneumonia,and could increased prognostic performance when combined with the PSI score.
引文
[1]Woodhead M,Welch CA,Harrison DA,et al.Community-acquired pneumonia on the intensive care unit:secondary analysis of 17,869cases in the ICNARC Case Mix Programme Database[J].Crit Care,2006,10(Suppl 2):S1.
[2]Welte T,Torres A,Nathwani D.Clinical and economic burden of community-acquired pneumonia among adults in Europe[J].Thorax,2012,67(1):71-79.
[3]Sibila O,Restrepo MI,Anzueto A.What is the best antimicrobial treatment for severe community-acquired pneumonia(including the role of steroids and statins and other immunomodulatory agents)[J].Infect Dis Clin North Am,2013,27(1):133-147.
[4]Lee JH,Kim J,Kim K,et al.Albumin and C-reactive protein have prognostic significance in patients with community-acquired pneumonia[J].J Crit Care,2011,26(3):287-294.
[5]Viasus D,Garcia-Vidal C,Simonetti A,et al.Prognostic value of serum albumin levels in hospitalized adults with community-acquired pneumonia[J].J Infect,2013,66(5):415-423.
[6]Bosch X,Formiga F,Cuerpo S,et al.Aspiration pneumonia in old patients with dementia.Prognostic factors of mortality[J].Euro J Int Med,2012,23(8):720-726.
[7]Ogasawara T,Umezawa H,Naito Y,et al.Procalcitonin-guided antibiotic therapy in aspiration pneumonia and an assessment of the continuation of oral intake[J].Res Invest,2014,52(2):107-113.
[8]Artero A,Zaragoza R,Camarena JJ,et al.Prognostic factors of mortality in patients with community-acquired bloodstream infection with severe sepsis and septic shock[J].J Crit Care,2010,25(2):276-281.
[9]Ewig S,Torres A.Community-acquired pneumonia as an emergency:time for an aggressive intervention to lower mortality[J].Euro Res J,2011,38(2):253-260.
[10]Espana PP,Capelastegui A,Quintana JM,et al.A prediction rule to identify allocation of inpatient care in community-acquired pneumonia[J].Euro Res J,2003,21(4):695-701.
[11]Menendez R,Martinez R,Reyes S,et al.Biomarkers improve mortality prediction by prognostic scales in community-acquired pneumonia[J].Thorax,2009,64(7):587-591.
[12]Chen JH,Chang SS,Liu JJ,et al.Comparison of clinical characteristics and performance of pneumonia severity score and CURB-65among younger adults,elderly and very old subjects[J].Thorax,2010,65(11):971-977.
[13]Pantzaris ND,Platanaki C,Pierrako C,et al.Neutrophil-to-lymphocyte Ratio Relation to Sepsis Severity Scores and Inflammatory Biomarkers in Patients with Community-acquired Pneumonia:A Case Series[J].J Transl Int Med,2018,6(1):43-46.
[14]方荣,王倩,欧阳洋,等.乳酸清除率与降钙素原及C反应蛋白和重症肺炎预后的相关性分析[J].临床急诊杂志,2018,19(7):463-467.
[15]Abers MS,Musher DM.Clinical prediction rules in community-acquired pneumonia:lies,damn lies and statistics[J].QJM,2014,107(7):595-596.
[16]Zhang ZX,Yong Y,Tan WC,et al.Prognostic factors for mortality due to pneumonia among adults from different age groups in Singapore and mortality predictions based on PSI and CURB-65[J].Singapore Med J,2018,59(4):190-198.
[17]Hedlund JU,Hansson LO,Ortqvist AB.Hypoalbuminemia in hospitalized patients with community-acquired pneumonia[J].Archives Int Med,1995,155(13):1438-1442.
[18]Yeon Lee S,Cha SI,Seo H,et al.Multimarker Prognostication for Hospitalized Patients with Community-acquired Pneumonia[J].Int Med,2016,55(8):887-893.
[19]Miyazaki H,Nagata N,Akagi T,et al.Comprehensive analysis of prognostic factors in hospitalized patients with pneumonia occurring outside hospital:Serum albumin is not less important than pneumonia severity assessment scale[J].J Infec Chem,2018,24(8):602-609.
[2]Welte T,Torres A,Nathwani D.Clinical and economic burden of community-acquired pneumonia among adults in Europe[J].Thorax,2012,67(1):71-79.
[3]Sibila O,Restrepo MI,Anzueto A.What is the best antimicrobial treatment for severe community-acquired pneumonia(including the role of steroids and statins and other immunomodulatory agents)[J].Infect Dis Clin North Am,2013,27(1):133-147.
[4]Lee JH,Kim J,Kim K,et al.Albumin and C-reactive protein have prognostic significance in patients with community-acquired pneumonia[J].J Crit Care,2011,26(3):287-294.
[5]Viasus D,Garcia-Vidal C,Simonetti A,et al.Prognostic value of serum albumin levels in hospitalized adults with community-acquired pneumonia[J].J Infect,2013,66(5):415-423.
[6]Bosch X,Formiga F,Cuerpo S,et al.Aspiration pneumonia in old patients with dementia.Prognostic factors of mortality[J].Euro J Int Med,2012,23(8):720-726.
[7]Ogasawara T,Umezawa H,Naito Y,et al.Procalcitonin-guided antibiotic therapy in aspiration pneumonia and an assessment of the continuation of oral intake[J].Res Invest,2014,52(2):107-113.
[8]Artero A,Zaragoza R,Camarena JJ,et al.Prognostic factors of mortality in patients with community-acquired bloodstream infection with severe sepsis and septic shock[J].J Crit Care,2010,25(2):276-281.
[9]Ewig S,Torres A.Community-acquired pneumonia as an emergency:time for an aggressive intervention to lower mortality[J].Euro Res J,2011,38(2):253-260.
[10]Espana PP,Capelastegui A,Quintana JM,et al.A prediction rule to identify allocation of inpatient care in community-acquired pneumonia[J].Euro Res J,2003,21(4):695-701.
[11]Menendez R,Martinez R,Reyes S,et al.Biomarkers improve mortality prediction by prognostic scales in community-acquired pneumonia[J].Thorax,2009,64(7):587-591.
[12]Chen JH,Chang SS,Liu JJ,et al.Comparison of clinical characteristics and performance of pneumonia severity score and CURB-65among younger adults,elderly and very old subjects[J].Thorax,2010,65(11):971-977.
[13]Pantzaris ND,Platanaki C,Pierrako C,et al.Neutrophil-to-lymphocyte Ratio Relation to Sepsis Severity Scores and Inflammatory Biomarkers in Patients with Community-acquired Pneumonia:A Case Series[J].J Transl Int Med,2018,6(1):43-46.
[14]方荣,王倩,欧阳洋,等.乳酸清除率与降钙素原及C反应蛋白和重症肺炎预后的相关性分析[J].临床急诊杂志,2018,19(7):463-467.
[15]Abers MS,Musher DM.Clinical prediction rules in community-acquired pneumonia:lies,damn lies and statistics[J].QJM,2014,107(7):595-596.
[16]Zhang ZX,Yong Y,Tan WC,et al.Prognostic factors for mortality due to pneumonia among adults from different age groups in Singapore and mortality predictions based on PSI and CURB-65[J].Singapore Med J,2018,59(4):190-198.
[17]Hedlund JU,Hansson LO,Ortqvist AB.Hypoalbuminemia in hospitalized patients with community-acquired pneumonia[J].Archives Int Med,1995,155(13):1438-1442.
[18]Yeon Lee S,Cha SI,Seo H,et al.Multimarker Prognostication for Hospitalized Patients with Community-acquired Pneumonia[J].Int Med,2016,55(8):887-893.
[19]Miyazaki H,Nagata N,Akagi T,et al.Comprehensive analysis of prognostic factors in hospitalized patients with pneumonia occurring outside hospital:Serum albumin is not less important than pneumonia severity assessment scale[J].J Infec Chem,2018,24(8):602-609.