APACHEⅡ、qSOFA、CURB-65评分对老年社区获得性肺炎患者短期预后的预测作用研究

Predictive Effect of APACHEⅡ,qSOFA and CURB-65 Scoring Systems on Short-term Prognosis in Elderly Patients with Community Acquired Pneumonia

目的探讨急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)、快速序贯器官衰竭(qSOFA)及CURB-65评分在老年社区获得性肺炎(community-acquired pneumonia,CAP)患者短期预后中的预测价值。方法回顾分析2017年1月—2019年10月我院呼吸内科诊治的196例老年CAP患者的临床资料,依据住院28 d生存状况分为存活组126例和死亡组70例。比较两组入院时APACHEⅡ、qSOFA、CURB-65评分,不同危险程度入院APACHEⅡ、qSOFA评分、CURB-65评分患者院内病死率,采用多因素Logistic回归分析探讨APACHEⅡ、qSOFA、CURB-65评分与老年CAP患者院内死亡的关系,并应用受试者工作特征(receiver operating characteristic,ROC)曲线分析APACHEⅡ、qSOFA、CURB-65评分预测老年CAP患者短期预后的价值。结果死亡组入院时APACHEⅡ、qSOFA、CURB-65评分均高于存活组(P<0.01),且APACHEⅡ、qSOFA、CURB-65评分低危、中危、高危患者院内病死率逐渐升高(P<0.05);多因素Logistic回归分析显示,入院时APACHEⅡ评分≥19.0分、qSOFA评分≥2.0分、CURB-65评分≥3.0分是老年CAP患者院内死亡的独立危险因素(P<0.01);APACHEⅡ、CURB-65评分预测老年CAP患者院内死亡的曲线下面积(AUC)高于qSOFA评分(Z=3.578,P=0.012;Z=4.260,P=0.005),而APACHEⅡ评分与CURB-65评分预测的AUC比较差异无统计学意义(Z=0.638,P=0.556)。结论APACHEⅡ评分与CURB-65评分预测老年CAP患者短期预后的价值均高于qSOFA评分,但CURB-65评分涉及指标相对较少,操作简单,且预测敏感性较高,可用于老年CAP患者预后的快速评估。

Objective To investigate the predictive value of Acquired Physiology and Chronic Health Evaluation(APACHEⅡ)score,the quick Sequential Organ Failure Assessment(qSOFA)and the CURB-65 score in the short-term prognosis in the elderly patients with community-acquired pneumonia(CAP).Methods The clinical data of 196 elderly patients with CAP diagnosed and treated in our hospital from January 2017 to October 2019 was retrospective analyzed,and the patients with CAP were divided into survival group(n=126)and death group(n=70)according to the 28-day survival status.APACHEⅡ,qSOFA and CURB-65 scores were compared between the two groups on admission.The relationship between APACHEⅡ,qSOFA,CURB-65 scores and in-hospital survival in elderly patients with CAP was analyzed by multivariate logistic regression.ROC curve was used to analyze the predict value of APACHEⅡ,qSOFA and CURB-65 scores in short-term prognosis of elderly CAP patients.Results The scores of APACHEⅡ,qSOFA and CURB-65 on admission were higher in the death group than those in the survival group(P<0.01),and the mortality rates of patients with low-risk,intermediate-risk and high-risk by APACHEⅡ,qSOFA and CURB-65 were gradually increased(P<0.05).Multivariate Logistic regression analysis showed that APACHEⅡscore≥19.0 points,qSOFA score≥2.0 points and CURB-65 score≥3.0 points on admission were independent risk factors for in-hospital death in elderly CAP patients(P<0.01).Values of area under the curve(AUC)predicted by APACHEⅡand CURB-65 score for in-hospital death in elderly CAP patients was higher than those by qSOFA score(Z=3.578,P=0.012;Z=4.260,P=0.005),but there was no significant difference in AUC value predicted by APACHEⅡand CURB-65 scores(Z=0.638,P=0.556).Conclusion The value of APACHEⅡscore and CURB-65 score in predicting the short-term prognosis of elderly CAP patients is higher than by the qSOFA score,but the CURB-65 score involves relatively fewer indicators,simpler operation and higher predictive sensitivity.It can quickly identify critically ill patients,and therefore it can be used for rapid assessment of the prognosis of elderly CAP patients.