qSOFA评分和NLCR预测成人社区获得性肺炎严重程度的价值

Value of qSOFA score and NLCR in predicting the severity of adult community acquired pneumonia

目的探讨快速序贯器官衰竭评估(qSOFA)评分、中性粒细胞-淋巴细胞比值(NLCR),预测成人社区获得性肺炎(CAP)为重症CAP和死亡的价值。方法回顾性研究299名CAP住院患者,依据患者肺炎的严重程度分为重症CAP组与非重症CAP组,依据患者28d内是否死亡,分为死亡组与存活组,比较各组之间qSOFA评分、NLCR值的差异,并通过绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC值),分析qSOFA评分、NLCR以及两者联合预测CAP患者为重症CAP、28d内死亡的价值。结果重症CAP组的qSOFA评分和NLCR值高于非重症CAP组,死亡组高于存活组(P<0.05)。qSOFA评分、NLCR和qSOFA评分联合NLCR预测重症CAP的AUC值分别为0.92、0.83、0.85;预测死亡的AUC值分别为0.89、0.78、0.79;qSOFA评分预测患者为重症CAP和死亡的AUC值均大于NLCR和两者联合的AUC值(P<0.05)。qSOFA评分、NLCR以及两者联合预测重症肺炎敏感度分别为54.3%、69.5%和83.7%;特异度分别为99.0%、87.4%和86.5%;三者预测患者死亡的敏感度分别为60.4%、66.0%和83.0%;特异度分别为92.8%、77.6%和75.2%。结论qSOFA评分和NLCR均可用于预测成人CAP的严重程度,qSOFA评分预测CAP严重程度的特异度较高,但敏感度较低,将其与NLCR联合可提高预测的敏感度。

Objective To investigate the value of rapid sequential sequential organ failure assessment(qSOFA)scores and neutrophil-lymphocyte ratio(NLCR)in predicting severity and death of adult community-acquired pneumonia(CAP).Methods A retrospective study was conducted among 299 hospitalized patients with community-acquired pneumonia recruited.They were divided into the severe community acquired pneumonia group and the non-severe community acquired pneumonia group,according to the severity of pneumonia.Besides,according to whether the patient died within 28 days,they were divided into the death group and the survival group.Finally,we compared the differences of qSOFA scores and NLCR between groups,then the predictive value of qSOFA scores,NLCR and their combination on the severity of CAP patients and death within 28 days were analyzed by drawing the receiver operating characteristic(ROC)curve.Results The qSOFA scores and the NLCR of the severe CAP group were higher than the non-severe CAP group,and the death group was higher than the survival group(P<0.05).The AUC values of the qSOFA scores,NLCR,and qSOFA score combined with NLCR for predicting severe CAP were 0.92,0.83,and 0.85,respectively.The AUC values of these three methods predicting death were 0.89,0.78,and 0.79,respectively.The AUC values of the qSOFA scores were greater than both the AUC values of NLCR and it combined with NLCR(P<0.05).The sensitivities of qSOFA scores,NLCR and qSOFA scores combined with NLCR predicting severe pneumonia were 54.3%,69.5%and 83.7%,respectively,and their specificities were 99.0%,87.4%and 86.5%,respectively.The sensitivities of these three methods predicting death were 60.4%,66.0%and 83.0%,and their specificities were 92.8%,77.6%and 75.2%,respectively.Conclusion Both qSOFA scores and NLCR can be used to predict the severity of CAP,the qSOFA scores has higher specificities,but its sensitivity is lower,and the combination with NLCR can improve the sensitivity of prediction.