重症社区获得性肺炎9项次要诊断标准权重分析

Weight of nine minor criteria for severe community-acquired pneumonia

治疗地点的抉择是治疗社区获得性肺炎（CAP）的关键，而这又取决于起始病情评估。在过去10年单．许多病情评估系统问世，获得证实，并应用于临床。如何定义重症CAP尚未定论。美国感染性疾病学会／美国胸科学会在2007年颁布成人CAP管理指南，并定义凡符合2项主要诊断标准之一或9项次要诊断标准中至少3项者为重症CAP。每项次要诊断标准预测病死率和入住重症监护病房的权重不一，且不同研究间存在显著分歧。重症监护病房资源的稀缺性要求临床医师能甄别入住者中孰能真正或最大程度受益，而探明每项次要诊断标准的权重无疑是甄别的核心。

A key step in the management of community acquired pneumonia （CAP） is the initial assessment of tbe severity of the disease. An accurate assessment helps clinicians determine the site of care. Over the past decade, anumherof prognostic （severity） scores have been derived and validated, and subsequenlly incorporated into clinical practice. However, how severe CAP should be defined remains unclear. The Infectious Disease Society of America and the American Thoracic Society issued guidelines in 2007 which defined severe CAP：when one of two major criteria or three of nine minor criteria are fulfilled. The individual minor criteria for severe CAP are of unequal weight in predicting mortality and intensive care unit （ICU） admission. A marked discrepancy with the weight between studies is observed. Because ICU resources are often scarce in many institutions, patients with CAP who would really or maximumly beriefit from ICU care should be identified by clinicians. The determination of the weight of the nine minor criteria provides pivotal discriminative information.