CURB-65、PSI、SMART-COP及APACHE Ⅱ评分在重症社区获得性肺炎患者早期诊断价值的比较

Comparison of value of CURB-65、PSI、SMART-COP and APACHE Ⅱ for early diagnosis in patients with severe community-acquired pneumonia

目的探讨及比较CURB-65、PSI、SMART-COP及APACHEⅡ4种临床评分对重症社区获得性肺炎(SCAP)患者的早期诊断价值。方法采用前瞻性研究方法,收集2011年10月—2014年2月广州市第一人民医院呼吸内科收治的67例SCAP及同期33例普通CAP患者的临床资料,记录入组后24小时内CURB-65、PSI、SMART-COP及APACHEⅡ评分的最差值,比较4种临床评分系统对SCAP的早期诊断价值。结果 SCAP组CURB-65、PSI、SMART-COP及APACHEⅡ评分均高于普通CAP组患者[CURB-65 (分):3. 06±1. 10比0. 85±0. 79,P <0. 001; PSI(分):144. 93±36. 48比73. 94±27. 17,P <0. 001; SMART-COP (分):6. 54±1. 41比1. 67±1. 02,P <0. 001; APACHEⅡ(分):20. 79±5. 69比7. 94±3. 87,P <0. 001]。CURB-65≥3分、PSI≥130分、SMARTCOP≥3分及APACHEⅡ≥15分诊断SCAP的受试者工作特征曲线(ROC)下面积(AUC)分别为0. 940 [95%CI:0. 89～0. 98,P <0. 001],0. 933 [95%CI:0. 88～0. 97, P <0. 001],0. 999 [95%CI:0. 99～1. 0, P <0. 001],0. 976 [95%CI:0. 95～0. 99,P <0. 001],敏感度分别为65. 6%、71. 6%、100%、88. 1%,特异度分别为100%、100%、78. 7%、93. 9%。结论 CURB-65及PSI评分特异度好,但敏感度低,易漏诊,SMART-COP和APACHEⅡ评分诊断效能更佳。

Objective To evaluate and compare the early diagnosis value of CURB-65, PSI, SMART-COP and APACHE Ⅱ in patients with severe eomnmnity-aequired pneumonia. Methods This was a prospective study conducted in department of respiratory- in Guangzhou First People＇s Hospital. We included 67 SCAP patients and 33 CAP patients between October of 2011and February- of 2014. The lowest scores within 24 hours of CURB-65 score, PSI score, SMART-COP score, APACHE Ⅱ score, respectively, for each patients were recorded. Prediction of SCAP as made in four scoring systems was compared. Results CURB-65 score, PSI score, SMART-COP score, APACHE Ⅱ score were higher in SCAP as compared with that of CAP（CURB-65：3.0 ± 1.1 vs 0.9 ±0.8, P 〈0.001; PSI： 144.6 ±36.4 vs 73.9 ±27.1, P 〈0.001; SMART-COP： 6.5 ±1.4 vs 1.6±1.0, P〈0.001; APACHEⅡ： 20.6 ±5.6 vs 7.9 ±3.8, P〈0.001）. ROC curve for CURB-65 score≥ 3 scores, PSI score≥ 130 scores, SMART-COP score≥3 scores and APACHE Ⅱ score ≥ 15 scores in the early diagnosis SCAP were 0. 940195% CI： 0. 89 - 0. 98, P 〈 0. 0011, 0. 933 195% CI： 0. 88 - 0. 97, P 〈 0. 0011, 0. 999 195 % CI： 0. 99 ~ 1.0, P 〈 0. 0011, 0. 976195% CI： 0. 95 ~ 0. 99, P 〈 0. 0011 - Sensitivity- of four kinds d scoring system was 65.6%, 71.6%, 100%, 88.1%, with specificity- of 100%, 100%, 78. 7%, 93.9% respectively-. Conclusion The specificity of diagnosis was better in the CURB-65 and PSI score, but the sensitivity- was low and easy to miss diagnosis. SMART-COP and APACHEⅡ score systems had a better diagnostic value on SCAP.