强化CURB评分在对肺炎合并免疫抑制的预测意义

The predictive role of enhanced CURB score in patients with pneumonia during combined immunosuppression treatment

目的探讨强化CURB评分对社区获得性肺炎（community acquired pneumonia，CAP）合并免疫抑制患者预后的预测价值。方法回顾性研究安徽医科大学第一附属医院2012年1月至2016年7月收治的156例CAP合并免疫抑制疾病患者，根据28d预后情况将其分为存活组和死亡组，比较两组间临床基本情况；通过计算强化CURB评分，CURB-65评分，qSOFA评分，以患者28d预后为临床观察终点，绘制受试者工作特征（ROC）曲线，比较曲线下面积（AUC），分析三种评分工具对CAP合并免疫抑制患者预后的预测价值。结果纳入研究156例患者，分别为存活组（134例）和死亡组（22例）。两组的强化CURB评分[8（6，10）分和12（9，13）分]，CURB-65评分[1（0，2）分和2（2，3）分]，sSOFA评分[0（0，1）分和1（0，1）分]比较，差异均有统计学意义（P〈0．05）。根据28d预后绘制ROC曲线，强化CURB评分AUC为0．815，灵敏度为50％，特异度为97．01％，最佳截断值11，P〈0．01；CURB-65评分AUC为0．816，灵敏度为81．82％，特异度为65．67％，最佳截断值1，P〈0．01；qSOFA评分AUC为0．642，灵敏度为54．5％，特异度为73．1％，最佳截断值0，P〈0．01；强化CURB评分与CURB-65评分比较差异无统计学意义，qSOFA评分与强化CURB，CURB-65分别比较，差异有统计学意义。结论强化CURB评分在评估CAP合并免疫抑制患者预后有较好的预测价值，灵敏度较低，但特异度优于CURB-65评分和qSOFA评分。

Objective To explore the predictive value of enhanced CURB score in the prognosis of patients with community-acquired pneumonia （CAP） in the setting of immunosuppressive therapy. Methods Retrospective study of 156 CAP patients with diseases treated with immunosuppressive agents admitted from January 2012 to July 2016 was carried out. The patients were divided into survival group and death group, and comparisons of demographics of patients and clinical sitting between two groups were performed. The receiver operator characteristic （ ROC ） curve was used for the calculations of enhanced CURB score, CURB-65 score and qSOFA score measured to predict the 28-day outcome of patients as the clinical observation endpoint. The predictive value of three scoring systems was compared in the prognosis of CAP patients under immunosuppressive treatment using the area under the curve （AUC）. Results Of 156 patients, there were 134 patients in survival group and 22 patients in death group. The statistically significant differences in measured results of three scoring systems between two groups were as follows：enhanced CURB score [8 （6, 10）vs. 12 （9, 13）], CURB-65 score [1 （0, 2）vs. 2 （2, 3）], and sSOFA score [ 0 （0, 1 ） vs. 1 （0, 1 ） ] （P 〈 0. 05 in 3 scoring systems）. According to ROC, the AUC of enhanced CURB score was 0. 815, with sensitivity 50%, specificity 97. 01%, the optimal cut-off value 11 （P 〈 0. 01 ） ; the AUC of CURB-65 score was 0. 816, with sensitivity 81.82%, specificity 65. 67%, the best cut-off value 1 （P 〈 0. 01 ） ; the AUC of qSOFA score was 0. 642, with sensitivity 54. 5 %, specificity 73.1%, the best cut-off value 0 （P 〈 0. 01 ）. There was a significant difference in score between qSOFA score and CURB-65 score, between qSOFA score and enhanced CURB score, but no significant difference between enhanced CURB score and CURB-65 score. Conclusions The enhanced CURB score has preferable predictive value in evaluating the prognosis of CAP patients during immunosuppressive treatment. Though its sensitivity is low, its specificity is superior to CURB-65 score and qSOFA＇ score.