qSOFA与CURB-65评分在成人社区获得性肺炎致脓毒症病情及预后评价中的作用

Comparison of the clinical value of qSOFA score and CURB-65 score on predicting the severity and prognosis of community-acquired pneumonia with sepsis

目的比较qSOFA评分和CURB-65评分在成人社区获得性肺炎(community-acquired pneumonia,CAP)所致脓毒症患者的病情严重程度和预后评价中的临床价值。方法回顾性分析2015年7月~2016年6月于四川大学华西医院急诊科就诊,诊断为成人CAP致脓毒症患者428例,其中男284例,女144例,平均年龄(60±17.43)岁。计算入院时的qSOFA及CURB-65评分,采用受试者工作特征曲线分析两种评分系统评估CAP致脓毒症的28天病死率的曲线下面积,并根据最佳临床分界点分组,比较两种评分方法评估CAP所致脓毒症的ICU平均住院天数、28天机械通气率和28天病死率的效能。结果 qSOFA评分及CURB-65评分评估CAP所致脓毒症28天病死率的曲线下面积分别为0.670(95%CI=0.611~0.729)和0.639(95%CI=0.578~0.700),两者均以2分为最佳临床分界点。qSOFA≥2分组和CURB-65≥2分组的ICU平均住院天数、28天机械通气率和28天病死率均分别高于qSOFA<2分组和CURB-65<2分组(P<0.05);qSOFA≥2分组的28天机械通气率和28天病死率均高于CURB-65≥2分组(P<0.05),但ICU平均住院天数的差异无统计学意义(P>0.05);qSOFA<2分组和CURB-65<2分组的ICU平均住院天数、28天机械通气率和28天病死率的差异均无统计学意义(P>0.05)。结论 qSOFA评分和CURB-65评分均有一定评估CAP致脓毒症的病情及预后的临床价值。但qSOFA评分较CURB-65评分能更好识别危重患者和预测不良预后。

Objective To comparative the clinical value of qSOFA score and CURB-65 score on predicting the severity and prognosis of community-acquired pneumonia（CAP）with sepsis in Emergency Department.Methods The clinical data of community-acquired pneumonia with sepsis of adult patients were collected retrospectively from July 1,2015 to June 30,2016 at the West China Hospital of Sichuan University.The qSOFA score and CURB-65 score were calculated at admission.The clinical value of qSOFA score and CURB-65 score on Predicting the 28-day mortality of community-acquired pneumonia with sepsis were compared by ROC curve analysis.According to the Cut off value divided into two groups.Comparative the efficacy of two scoring methods on predicting the average hospital stay of ICU,the 28-day mechanical ventilation and the 28-day mortality.Results 428 patients were included,including male 284 cases,female144 cases,the average age of 60 ± 17.43 years old.The area under the curves of 28-day mortality of CAP with sepsis assessed by the qSOFA score and CURB-65 score were 0.670（95% CI= 0.611 - 0.729）,0.639（95% CI= 0.578-0.700）respectively.Both cutoff values are 2 points.The ICU average length of hospital stay、28-day mechanical ventilation and 28-day mortality were significantly higher in qSOFA≥2 group and CURB-65≥2 group than those in qSOFA〈2 group and CURB-65〈2 group respectively（P〈0.05）.The 28-day mechanical ventilation and 28-day mortality were higher in the qSOFA≥2 group than in the CURB-65≥2 group（P〈0.05）,but there was no significant difference between the two groups（P〈0.05）.The ICU average length of stay、28-day mechanical ventilation and 28-day mortality were no significant difference between qSOFA2 group and CURB-652 group（P〈0.05）.Conclusion The qSOFA score and CURB-65 score all have the clinical value on predicting the severity and prognosis of CAP with sepsis in Emergency Department.However,the qSOFA score is better than the CURB-65 score to identify critically ill patients and predict poor prognosis.