不同评分系统对慢性阻塞性肺疾病急性加重患者28天生存率的预测价值

Predictive value of different scoring systems for 28-day survival rate in patients with acute exacerbation of chronic obstructive pulmonary disease

目的:探讨不同评分系统对慢性阻塞性肺疾病急性加重期(AECOPD)患者28 d生存率的预测价值。方法:收集AECOPD患者150例,均进行积极常规救治,采用BAP-65评分、急性生理与慢性健康状况评分Ⅱ(APACHEⅡ)及慢性阻塞性肺疾病和支气管哮喘生理评分(CAPS)对28 d生存率进行预测。根据预后将患者分为死亡组12例和存活组138例。结果:死亡组患者APACHEⅡ评分与CAPS评分均明显高于存活组(P<0.05),两组BAP-65评分差异有统计学意义(P<0.05)。3种评分系统中APACHEⅡ评分对AECOPD患者28 d生存率预测曲线下面积最大,为0.917,且其敏感性及特异性均最大,分别为89.06%及83.88%,CAPS评分与BAP-65评分曲线下面积分别为0.828、0.888,且诊断敏感性及特异性均在70%以上。结论:BAP-65评分、APACHEⅡ评分及CAPS评分对AECOPD患者28 d生存率均有较高的预测价值,且APACHEⅡ评分预测价值最佳。

Objective: To investigate the value of different scoring systems in predicting 28-day survival rate in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD). Methods: A total of 150 AECOPD patients were enrolled. All patients underwent routine treatment with a BAP-65 score, APACHE Ⅱ score, and CAPS score to predict 28-day survival. Patients were divided into death group(12 cases) and survival group(138 cases) according to the prognosis of patients. Results: The APACHE Ⅱ score and CAPS score in the death group were significantly higher than those in the survival group(P<0.05). The difference in BAP-65 scores between the two groups was statistically significant(P<0.05). The ROC results showed that the APACHE Ⅱ score in the three scoring systems had the largest area under the 28-day survival rate prediction curve for AECOPD patients, and the sensitivity and specificity were 89.06% and 83.88%, respectively. The CAPS score and BAP-65 score curves were obtained. The lower area was 0.828 and 0.888, respectively, and the diagnostic sensitivity and specificity were above 70%. Conclusion: The BAP-65 score, APACHE Ⅱ score and CAPS score have a higher predictive value for 28-day survival rate in patients with AECOPD, and the predictive value of the APACHE Ⅱ score is the highest.