脑出血评分对原发性脑出血患者发生卒中相关性肺炎的预测价值

Predictive value of intracerebral hemorrhage score for stroke-associated pneumonia in patients with primary intracerebral hemorrhage

目的探讨脑出血评分对原发性脑出血患者发生卒中相关性肺炎(SAP)的预测价值。方法回顾性连续性纳入2014年1月至2015年7月在上海市嘉定区中心医院急诊科就诊的脑出血患者209例,分析患者的一般资料,根据住院期间是否发生SAP,分为SAP组(73例)和非SAP组(136例)。以脑出血评分为评估依据,分析SAP的发生率及病死率;以脑出血评分预判SAP的发生,绘制受试者工作特征曲线,并计算敏感度、特异度及最佳截值。结果 (1)脑出血患者SAP的发生率为34.9%(73/209),病死率为21.1%(44/209)。(2)SAP组和非SAP组的年龄分别为(73±12)和(63±14)岁,血肿体积为23.4(9.6,51.1)和6.2(3.1,16.0)ml,脑出血评分为2(1,3)和1(0,2),两组差异均有统计学意义(均P<0.01)。SAP组比非SAP组格拉斯哥昏迷评分显著降低[8(4,11)分和15(13,15)分,P<0.01]。以脑出血评分预判SAP发生的受试者工作特征曲线下面积为0.775(95%CI:0.709~0.842,P<0.01)。当约登指数最大值为0.453时,对应的脑出血评分最佳截值为2分,其敏感度为74%,特异度为71%,阳性预测值为0.58,阴性预测值为0.84。结论脑出血患者SAP的发生率较高,脑出血评分有一定预测SAP发生的临床价值,临床需重视脑出血评分≥2分的脑出血患者发生SAP的风险。

Objective To investigate the predictive value of intracerebral hemorrhage（ICH） score for stroke-associated pneumonia（SAP） in patients with primary intracerebral hemorrhage. Methods From January 2014 to July 2015,209 consecutive patients with ICH at the Emergency Department,Shanghai Jiading District Central Hospital were enrolled retrospectively. The general information of the patients were analyzed.They were divided into either a SAP group（n = 73） or a non-SAP group（n = 136） according to whether they had SAP or not. Based on the ICH score,the incidence and mortality of SAP were analyzed; the occurrence of SAP was prejudged by ICH score. The ROC curve was plotted,and the sensitivity,specificity and the best cut-off value were calculated. Results（1） The incidence of SAP was 34. 9%（73/209）and the mortality was 21. 1%（44/209） in patients with ICH.（2） There were significant differences in age（73 ± 12 and 63 ± 14）,hematoma volume（23. 4 [9. 6,51. 1] and 6. 2 [3. 1,16. 0],and ICH score（2[1,3]and 1 [0,2]） between the SAP group and the non-SAP group（all P〈0. 01）. Compared with non-SAP group,Glasgow coma scale（GCS） score of the SAP group was significantly decreased（8 [4,11]and 15 [13,15],P〈0. 01）. The area under the ROC curve of the ICH score predicting the occurrence of SAP was 0. 775（95% CI 0. 709-0. 842,P〈0. 01）. When the maximum Youden index was 0. 453,the best cut-off value of the corresponding ICH score was 2,its sensitivity was 74%,specificity was 71%,the positive predictive value was 0. 58,and the negative predictive value was 0. 84. Conclusions The incidence of SAP in patients with ICH is higher. The ICH score may predict the clinical value of the occurrence of SAP.Clinical attention should be paid to the risk of occurring SAP in patients with ICH whose ICH score ≥2.