CURB-65评分联合血尿素氮/白蛋白对社区获得性肺炎临床价值的研究

Clinical value of CURB-65 score combined with blood urea nitrogen to albumin ratio in community-acquired pneumonia

目的评估CURB-65评分联合血尿素氮与白蛋白比值(blood urea nitrogen to albumin ratio,B/A)对成人社区获得性肺炎(community acquired pneumonia,CAP)患者住院期间入住重症医学科(intensive care unit,ICU)及死亡的预测价值。方法回顾性收集昆明医科大学第二附属医院2018年1月—2022年1月住院治疗的523例CAP患者资料,根据患者是否入住ICU分为ICU组(n=36)和普通病房组(n=487),根据患者住院期间死亡情况分为死亡组(n=45)与非死亡组(n=478),分别比较两组患者的基本资料(年龄、性别、基础疾病史等)、住院天数、抗生素使用天数、CURB-65评分、白细胞计数(white blood cell count,WBC)、中性粒细胞计数(neutrophil count,NEUT)、降钙素原(procalcitonin,PCT)、C反应蛋白(C-reactive protein,CRP)、血清白蛋白(albumin,Alb)、血尿素氮(blood urea nitrogen,BUN)及B/A有无差异,绘制受试者操作特征曲线(receiver operator characteristic curve,ROC曲线)评估CURB-65评分、B/A以及二者联合对CAP患者入住ICU及住院期间死亡的预测价值,采用Logistic回归分析CAP患者院内死亡的危险因素。结果入住ICU组患者住院天数、抗生素使用天数、住院期间死亡人数、合并高血压、糖尿病比例、CURB-65评分、WBC、NEUT、PCT、CRP、BUN、B/A显著高于普通病房组,死亡组患者年龄、男性、合并高血压、糖尿病、冠心病比例、入住ICU比例、CURB-65评分、WBC、NEUT、PCT、CRP、BUN、B/A显著高于非死亡组,入住ICU组及死亡组患者Alb降低(均P<0.05)。相关性分析显示B/A与PCT、CRP、WBC、NEUT、CURB-65评分呈正相关(相关系数r值分别为0.486、0.291、0.260、0.310、0.666,均P<0.001),CURB-65评分联合B/A预测CAP患者入住ICU及住院期间死亡的ROC曲线下面积分别为0.862[95%置信区间(confidential interval,CI)0.807~0.918,敏感性91.7%,特异性66.4%]和0.908(95%CI 0.864~0.952,敏感性93.3%,特异性75.7%)。多因素Logistic回归分析显示合并糖尿病、CURB-65评分高、Alb水平降低和B/A≥4.755 mg/g是CAP患者住院期间死亡的独立危险因素(P<0.05)。结论B/A升高与CAP患者ICU需求及死亡有显著相关性,联合运用可以提高CURB-65评分对CAP患者入住ICU及死亡的预测价值。

Objective To evaluate the predictive value of CURB-65 score combined with blood urea nitrogen to albumin ratio(B/A)for intensive care unit(ICU)admission and death in adults with community-acquired pneumonia(CAP).Methods A retrospective analysis was performed on 523 patients with CAP hospitalized in the Second Affiliated Hospital of Kunming Medical University from January 2018 to January 2022.According to whether the patients were admitted to ICU,they were divided into an ICU group(n=36)and a general ward group(n=487).The patients were divided into a death group(n=45)and a non-death group(n=478)according to the death situation during hospitalization.Basic data(age,gender,history of underlying diseases,etc.),hospital stay,antibiotic use days,CURB-65 score,white blood cell count(WBC),neutrophil count(NEUT),procalcitonin(PCT),C-reactive protein(CRP),serum albumin(Alb),blood urea nitrogen(BUN),and BUN to Alb ratio(B/A)of the two groups were compared respectively.Receiver operating characteristic(ROC)curve were plotted to evaluate the predictive value of CURB-65 score,B/A,and their combination for death during ICU admission and hospitalization in patients with CAP.Logistic regression was used to analyze risk factors for in-hospital death in the patients with CAP.Results The number of days in hospital,the number of days of antibiotic use,the number of deaths during hospitalization,the proportion of hypertension,diabetes,CURB-65 score,WBC,NEUT,PCT,CRP,BUN and B/A in the ICU group were significantly higher than those in the general ward group.Age,male,combined hypertension,diabetes,coronary heart disease,ICU admission,CURB-65 score,WBC,NEUT,PCT,CRP,BUN and B/A in the death group were significantly higher than those in the non-death group,and Alb in the ICU group and the death group were significantly lower(all P<0.05).Correlation analysis showed that B/A was positively correlated with PCT,CRP,WBC,NEUT and CURB-65 scores(correlation coefficient r values were 0.486,0.291,0.260,0.310,0.666,all P<0.001).The area under ROC curve of CURB-65 combined with B/A to predict ICU admission and death of CAP patients was 0.862(95%CI 0.807-0.918,sensitivity 91.7%,specificity 66.4%)and 0.908(95%CI 0.864-0.952,sensitivity 93.3%,specificity 75.7%),respectively.Multivariate logistic regression analysis showed that diabetes,high CURB-65 score,low Alb level and B/A≥4.755 mg/g were independent risk factors for death of CAP patients during hospitalization(P<0.05).Conclusions There is a significant correlation between elevated B/A and ICU demand and mortality in CAP patients.Combined use can improve the predictive value of CURB-65 score for ICU admission and mortality in CAP patients.