CURB-65评分和强化CURB评分对老年重症社区获得性肺炎预测价值的临床研究

A clinical study about prognostic value of CURB -65 and enhanced CURB scores in older adults with severe community acquired pneumonia

目的比较CURB一65评分和强化CURB评分对老年重症社区获得性肺炎（severe community acquired pneumonia，SCAP）预后的临床预测价值。方法回顾性分析2009—12—2015-07入住我院急诊科、呼吸内科以及老年呼吸内科的87例老年SCAP相关临床资料，分别统计每例患者的CURB-65评分、强化CURB评分，以患者28d预后为临床观察终点，绘制受试者工作特征（receiver operator characteristic，ROC）曲线，通过比较曲线下面积（area under the curve，AUC）分析两种评分工具对老年SCAP预后的预测价值。结果87例患者CURB一65评分为3（2—3）分，强化CURB评分为11（10～12）分。死亡组中CURB-65评分和强化CURB评分均明显高于存活组，差异有统计学意义（P〈0．05）。强化CURB评分AUC为0．722，最佳截断值为12，敏感度为58．82％，特异度为69．81％，P=0．0001；CURB-65评分AUC为0．660，最佳截断值为3，敏感度为73．53％，特异度为49．06％，P=0．0091。强化CURB评分AUC大于CURB-65评分，差异有统计学意义（0．722vs．0．660，Z=2．176，P=0．029）。结论CURB-65评分和强化CURB评分均可预测老年SCAP预后，强化CURB评分预测价值高于CURB-65评分，且其特异度高于CURB-65评分。

Objective To compare the values of CURB -65 and enhanced CURB scores in predicting mortality in older adults with severe community - acquired pneumonia. Methods A retrospective study of total 87 older adults with severe community - acquired pneumonia hospitalized into emergency department, respiratory and elderly respiratory from December 2009 to July 2015 were analyzed, CURB- 65 and enhanced CURB scores were calculated respectively. According to prognosis of 28 days for the end of observation, drawing the receiver- operating characteristic（ROC） curve of the two scores and comparing their area under the curve （AUC） to determine the predictive value of prognosis. Results The CURB - 65 and enhanced CURB scores of 87 patients were 3 （2 - 3 ） and 11 （ 10 ~ 12） respectively. The CURB -65 and enhanced CURB scores of the death group were higher than those of the survival group（P 〈0.05）. The AUC of enhanced CURB score was 0.722, the best cut - off value was 12 （sensitivity 58.82%, specificity 69.81%, P = 0001 ） ;the AUC of CURB -65 score was 0. 660, and the best cut - off value was 3 （ sensitivity 73.53%, specificity 49.06%, P = 0. 0091 ）. The AUC of enhanced CURB was larger than that of CURB - 65 （0. 722 vs. 0. 660,Z = 2. 176,P = 0.029）. Conclusion CURB -65 and enhanced CURB scores all can predict the mortality of the older patients with SCAP, but enhanced CURB performs better than CURB -65 ,because the specificity is higher than that of the CURB - 65 score.