两种基础疾病评分预测肺炎患者预后的比较

Comparison of predictive value between two kinds of score system in hospital mortality of pneumonia patients

目的比较慢性健康状态评分（chronichealthscore，CHS）和查尔森合并症指数（Charlson’sweightedindexofcomorbidities，WIC）对ICU肺部感染患者住院死亡风险的影响。方法回顾性分析多中心2013年9月至2014年9月肺炎患者的临床资料；记录性别、年龄、既往基础疾病、是否严重脓毒症；计算入院时WIC、人院后24h急性生理与慢性健康状况（APACHE）评分Ⅱ，包括CHS、急性生理状况评分（acutephysiologyscore，APS）和脓毒症相关性器官功能衰竭评分（sepsisrelatedorganfailureassessment，SOFA）。结果在293名入组患者中，男性195例（66．6％），女性98例（33．4％），存活197例（67．2％），死亡96例（32．8％）。年龄（62．5±17．0）岁。与存活组比较，死亡组的WIC评分较高。而两组的CHS评分比较无统计学意义。随着WIC和CHS分值的增高，患者的病死率呈增高趋势。单因素Logistic回归分析显示年龄、APACHEⅡ、SOFA、APS、CHS、WIC、是否严重脓毒症、基础疾病中Ⅱ型糖尿病、卒中、充血性心力衰竭与患者的预后相关。CHS（方程1）和WIC评分（方程2）分别联合入院急性生理状况评分及年龄等因素建立方程行多因素Logistic回归分析提示年龄、APS、CHS、WIC、是否严重脓毒症与患者的28d预后独立相关。CHS评分的受试者工作曲线下面积（AUC）为0．557，95％CI：（0．49～0．623）低于（P=0．0217，Z=2．296）WIC评分的AUC=0．64995％CI：（0．586-0．712），联合多变量建立方程后的AUC明显优于APACHEⅡ评分（P〈0．001）。结论WIC评分是预测ICU肺炎患者住院病死率的独立风险因素；WIC评分较CHS评分可以更好的评价基础疾病对患者病死率的影响。

Objective To compare the value in predicting hospital mortality of pneumonia patients between Charlson＇ s weighted index of comorbidities （WIC） and chronic health score （CHS）, in Intensive Care Units （ICU）. Methods The clinical data of pneumonia patients collected from September 2013 to September 2014 in ICU of two centers were retrospectively analyzed . The data included sex, age, comorbidites, past history about diseases contracted, presence or absence of severe sepsis. W1C and the acute physiology score （ APS ） , age, chronic health evaluation Ⅱ （ APACHE Ⅱ） score including CHS, APS, age scores, and sepsis related organ failure assessment （SOFA） were calculated. Results Of 293 patients, there are 195 （66.6%） males and 98 （33.4%） females; 197 （67.2%） survivors and 114（33.7%） non-survivors. The average age was （62. 5 ± 17.0） years. Compared with survivors, WIC scores were higher in non-survivors. However, the difference in CHS between two groups was not statistically significant. Along with the increase of WIC and CHS score, the patients mortality was increased. The univariate analysis showed that the variables including age, APACHE Ⅱ score, SOFA, APS, CHS, WIC, and presence or absence of severe sepsis, diabetes, stroke and congestive cardiac failure were related with patientss＇ prognosis in 28 days. The univariate logistic regression of CHS （ model 1 ） or WIC （ model 2 ） combine with age, APS, presence or absence of severe sepsis and main eomorbidities, such as diabetes, stroke and congestive cardiac failure indicated that risk of death depended significantly on age, APS, CHS, WIC, presence or absence of severe sepsis. The area under the receiver operating characteristics curve （ROC） in predicting mortality was 0. 557 95% CI： （0. 49-0. 623） for CHS, it was lower than the 0. 649 95%CI： （0.586-0.712） for WIC （P =0.206, Z =2.315）. The AUC of multivariable equations was significantly better than that of APACHE Ⅱ score （ P 〈 0. 01 ）. Conclusions The WIC and CHS were independent risk factors for in-hospital mortality of pneumonia patients in ICU. WIC was better than CHS in evaluating eomorbidity.