老年营养风险评分联合肺炎严重程度评分评价老年肺炎的预后

Value of geriatric nutritional risk index combining pneumonia severity index in predicting prognosis in elderly patients with pneumonia

目的分析老年营养风险评分(GNRI)联合肺炎严重程度评分(PSI)对老年社区获得性肺炎(CAP)病人短期预后的评估价值。方法回顾性分析2015年7月至2016年6月连续收住首都医科大学宣武医院急诊科病房年龄>65岁的CAP病人200例,以GNRI=92分及PSI=91分为界限,分为以下4组:A组(GNRI<92分,PSI≥91分);B组(GNRI<92分,PSI<91分),C组(GNRI≥92分,PSI≥91分);D组(GNRI≥92分,PSI<91分);比较各组住院期间机械通气的发生率、住院死亡率和出院病人14 d内再住院率的差异。分别以GNRI联合PSI,单用GNRI及单用PSI水平预测住院死亡率,作受试者工作特征曲线(receiver operating characteristic curve,ROC),计算曲线下面积(AUC)。结果 (1)4组机械通气发生率、住院死亡率和14 d内再住院率比较,差异均有统计学意义(P<0.05)。(2)预测住院死亡率ROC曲线比较,GNRI联合PSI的AUC为0.751(95%CI:0.638~0.865,P=0.001),高于单用GNRI或单用PSI。结论肺部感染程度及营养风险水平与老年病人的预后息息相关,使用GNRI联合PSI能更好地预测老年CAP病人住院死亡率。

Objective To analyze the value of geriatric nutritional risk index（ GNRI） combining pneumonia severity index（ PSI） in predicting the short-term prognosis in elderly patients with community acquired pneumonia（ CAP）. Methods A total of 200 elderly patients with CAP admitted in Emergency Department of Xuanwu Hospital of Capital Medical University from July 2015 to June2016 were enrolled. All patients were divided into four groups according to the scores of GNRI and PSI as follows： group A（ GNRI 92,PSI≥91）,group B（ GNRI 92,PSI 91）,group C（ GNRI≥92,PSI≥91）,group D（ GNRI ≥92,PSI 〈91）. Incidence rates of mechanical ventilation,hospital mortality and14-day re-admission were compared between four groups. The predicting effects of GNRI combining PSI,GNRI only or PSI only on hospital mortality were evaluated by making receiver operating characteristic（ ROC） curve and calculating the area under curve（ AUC）. Results（ 1） There were significant differences in the incidence rate of mechanical ventilation,hospital mortality and 14-day readmission among the four groups（ P〈0. 05）.（ 2） The ROC of GNRI combining PSI in predicting hospital mortality showed the AUC of 0. 751（ 95% CI： 0. 638-0. 865,P = 0. 001）,which was higher than that of GNRI only or PSI only. Conclusions The prognosis of elderly patients with CAP is related to the degree of infection and the nutritional risk. Combination of GNRI and PSI can improve the accuracy in predicting hospital mortality.