CURB-65、PSI、APACHE Ⅱ评分在重症肺炎患者预后评估中的应用
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摘要
目的:探讨CURB-65、PSI、APACHEⅡ评分在评估重症肺炎(SP)患者预后中的应用价值。方法:选取2016年11月至2018年10月广州医科大学附属第三医院收治的108例SP患者,依据生存预后分为死亡组(48例)和生存组(60例),同期选取非SP患者50例作为对照组。分析CURB-65、PSI、APACHEⅡ评分对SP患者预后的评估价值。结果:SP患者CURB-65、PSI、APACHEⅡ评分明显高于非SP患者(P<0.05);死亡组CURB-65、PSI、APACHEⅡ评分明显高于生存组(P<0.05); ROC曲线分析显示,在评估SP患者死亡预后的敏感度、特异度、准确度中,CURB-65>3分时为83.33%,85.00%,84.26%,PSI>120分时为84.25%,83.33%,82.41%,APACHEⅡ>17分时为87.50%,85.00%,86.11%,三者联合时为95.83%,96.67%,96.30%,三者联合明显高于三者单独(P<0.05)。结论:CURB-65、PSI、APACHEⅡ评分与SP病情及预后有关,均可作为评估患者预后的重要方法,且三者联合时评估效能更佳。
Objective: To investigate the value of CURB-65,PSI and APACHE II scores in evaluating the prognosis of patients with severe pneumonia( SP). Methods: Included in this study were 108 SP patients admitted to Third Affiliated Hospital of Guangzhou Medical University between November 2016 and October 2018.According to survival prognosis,they were assigned to the death group( n = 48) and survival group( n = 60). A contemporary cohort of 50 non-SP patients were selected as control group. The value of CURB-65,PSI,and APACHE II scores in evaluating the prognosis of SP patients was investigated. Results: The CURB-65,PSI and APACHE II scores in the SP patients were significantly higher than those in the non-SP patients( P<0.05). The CURB-65,PSI and APACHEII scores in the death group were significantly higher than those in the survival group( P<0.05). ROC curve analysis showed that sensitivity,specificity and accuracy for predicting death in the SP patients were: 83.33%,85.00% and 84.26% based on CURB-65 score> 3; 84.25%,83.33% and 82.41% based on PSI score >120; 87.50%,85.00% and 86.11% based on APACHE II > 17; 95.83%,96.67% and 96.30%when the three were used in combination. These data were higher when the three were used in combination than any one used alone( P < 0. 05). Conclusion: CURB-65,PSI,APACHE II scores are related to severity and prognosis of SP,and can be used as important tools to predict the prognosis of patients. The prediction efficiency seems better with the three used in combination.
Objective: To investigate the value of CURB-65,PSI and APACHE II scores in evaluating the prognosis of patients with severe pneumonia( SP). Methods: Included in this study were 108 SP patients admitted to Third Affiliated Hospital of Guangzhou Medical University between November 2016 and October 2018.According to survival prognosis,they were assigned to the death group( n = 48) and survival group( n = 60). A contemporary cohort of 50 non-SP patients were selected as control group. The value of CURB-65,PSI,and APACHE II scores in evaluating the prognosis of SP patients was investigated. Results: The CURB-65,PSI and APACHE II scores in the SP patients were significantly higher than those in the non-SP patients( P<0.05). The CURB-65,PSI and APACHEII scores in the death group were significantly higher than those in the survival group( P<0.05). ROC curve analysis showed that sensitivity,specificity and accuracy for predicting death in the SP patients were: 83.33%,85.00% and 84.26% based on CURB-65 score> 3; 84.25%,83.33% and 82.41% based on PSI score >120; 87.50%,85.00% and 86.11% based on APACHE II > 17; 95.83%,96.67% and 96.30%when the three were used in combination. These data were higher when the three were used in combination than any one used alone( P < 0. 05). Conclusion: CURB-65,PSI,APACHE II scores are related to severity and prognosis of SP,and can be used as important tools to predict the prognosis of patients. The prediction efficiency seems better with the three used in combination.
引文
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[13]赵建美,马伟.老年社区获得性肺炎患者血浆D-二聚体水平及其与病情严重程度的关系[J].山东医药,2015,55(6):59-60.
[14]裴兴华,于海明,吴艳红,等. APACHEⅡ评分与老年重症肺炎需有创机械通气患者谵妄发生的关系[J].中华危重病急救医学,2017,29(9):821-824.
[15]李晓如,李志军,王东强,等. APACHEⅡAPACHEⅢ评分及PSI评分评估老年重症肺炎预后的对比研究[J].中国急救医学,2015,35(11):1013-1016.
[16]Frazier SB,Sepanski R,Mangum C,et al. Association of sys-temic inflammatory response syndrome with clinical outcomesof pediatric patients with pneumonia[J]. South Med J,2015,108(11):665-669.
[17]徐悦利,张阳,姜锋,等.不同严重程度社区获得性肺炎患者凝血及纤溶相关指标的比较[J].中华医学杂志,2015,95(24):1925-1929.
[18]李星晶,王鹏,沈芳,等.肺炎严重度指数和CURB-65评分对老年社区获得性肺炎预后评估的比较[J].中华全科医师杂志,2014,13(2):133-134.
[19]莫必华,刘艳秀,黄政,等. APACHEⅡ评分在重症肺炎病人撤机中的预测价值[J].蚌埠医学院学报,2017,42(3):317-319,322.
[20]陈映红,熊涛.不同炎性指标评估重症肺炎患者病情变化的临床对比研究[J].检验医学与临床,2017,14(7):926-928.
[2]王玉瑛,韩波,高怡玢,等.早期CPAP对小儿重症肺炎并呼吸衰竭血气指标及预后的影响[J].临床肺科杂志,2016,21(1):75-78.
[3] Liapikou A,Polverino E,Cilloniz C,et al. Aworldwide perspective of nursing home-acquiredpneumonia compared with community-acquiredpneumonia[J]. Respir Care,2014,59(7):1078-1085.
[4]孙广信,石彦杰,侯伟鹏,等.支气管肺泡灌洗液中可溶性尿激酶型纤溶酶原激活物受体对重症社区获得性肺炎病情和预后评估价值[J].中国呼吸与危重监护杂志,2016,15(6):562-566.
[5]瞿介明,曹彬.中国成人社区获得性肺炎诊断和治疗指南(2016年版)修订要点[J].中华结核和呼吸杂志,2016,39(4):241-242.
[6] Don M,Valerio G,Canciani M. Hyponatremia in radiologically confirmed pediatric community-acquired pneumonia[J].Pediatric Emergency Care,2014(1):86-87.
[7]赵飞,顾伟.降钙素原联合CURB-65评分和肺炎严重度指数评分(PSI)对社区获得性肺炎严重程度的评估价值[J].中国医刊,2017,52(5):56-59.
[8]杨军,李劲松.APACHEⅡ评分、血清降钙素原和白介素-6与重症肺炎预后的关系[J].四川医学,2015,36(3):362-364.
[9] Sin JW,Tsu TY,Shun CC,et al. Pelvic primary pyomyositis complicated by septic pulmonary embolism and shock in a young adult[J]. J Med Sci,2014,4(2):88-90.
[10]焦淑芳.经鼻持续气道正压通气治疗小儿重症肺炎合并呼吸衰竭的临床疗效及预后观察[J].中国妇幼保健,2014,29(13):2117-2118.
[11] Antonello N,Grazia PI,Cornelius B. The role of noninvasive positive pressure ventilation in communityacquired pneumonia:which criteria predict success or failure[J]. J Crit Care,2015,30(3):648-648.
[12]郑伟.改良CURB-65评分联合凝溶胶蛋白对评估重症肺炎的临床研究[J].临床肺科杂志,2015,(11):2070-2072.
[13]赵建美,马伟.老年社区获得性肺炎患者血浆D-二聚体水平及其与病情严重程度的关系[J].山东医药,2015,55(6):59-60.
[14]裴兴华,于海明,吴艳红,等. APACHEⅡ评分与老年重症肺炎需有创机械通气患者谵妄发生的关系[J].中华危重病急救医学,2017,29(9):821-824.
[15]李晓如,李志军,王东强,等. APACHEⅡAPACHEⅢ评分及PSI评分评估老年重症肺炎预后的对比研究[J].中国急救医学,2015,35(11):1013-1016.
[16]Frazier SB,Sepanski R,Mangum C,et al. Association of sys-temic inflammatory response syndrome with clinical outcomesof pediatric patients with pneumonia[J]. South Med J,2015,108(11):665-669.
[17]徐悦利,张阳,姜锋,等.不同严重程度社区获得性肺炎患者凝血及纤溶相关指标的比较[J].中华医学杂志,2015,95(24):1925-1929.
[18]李星晶,王鹏,沈芳,等.肺炎严重度指数和CURB-65评分对老年社区获得性肺炎预后评估的比较[J].中华全科医师杂志,2014,13(2):133-134.
[19]莫必华,刘艳秀,黄政,等. APACHEⅡ评分在重症肺炎病人撤机中的预测价值[J].蚌埠医学院学报,2017,42(3):317-319,322.
[20]陈映红,熊涛.不同炎性指标评估重症肺炎患者病情变化的临床对比研究[J].检验医学与临床,2017,14(7):926-928.