社区获得性肺炎患者发生临床严重事件的预测方法研究

Prediction methods of clinical severe events in patients with community acquired pneumonia

目的探讨社区获得性肺炎(CAP)患者发生临床严重事件的独立影响因素,寻找简便、有效、更准确的预测方法。方法回顾性分析我院呼吸与危重症医学科2018年8月至2019年7月间诊断为CAP患者的临床资料,以住院期间发生临床严重事件(入住重症加强治疗病房、使用机械通气或血管活性药物、30天内死亡)为终点事件,将患者分为严重事件组和非严重事件组,比较两组的临床资料,并建立多因素Logistic回归模型分析CAP患者发生临床严重事件的独立影响因素。绘制受试者操作特征曲线(ROC),计算和比较各预测方法的曲线下面积(AUC)。结果共纳入CAP患者410例,其中96例(23.4%)患者发生临床严重事件。入院时年龄(OR:1.035,95%CI:1.012~1.059,P=0.003)、血清高密度脂蛋白(HDL)水平(OR:0.266,95%CI:0.088~0.802,P=0.019)及乳酸脱氢酶(LDH)水平(OR:1.006,95%CI:1.004~1.059,P<0.001)为CAP患者发生临床严重事件的独立影响因素。CURB65和肺炎严重度指数(PSI)评分预测严重事件的AUC分别为0.744(95%CI:0.699~0.785,P=0.028)和0.814(95%CI:0.772~0.850,P=0.025)。CURB65联合HDL和LDH建立的预测方法—CURB65-LH,在所有预测方法中其AUC最大0.843(95%CI:0.804~0.876,P=0.022),敏感性(69.8%)和特异性(81.5%)也分别较CURB65高(61.5%和76.1%)。结论CURB65-LH是一个简便、有效、更准确的预测方法,与传统的CURB65相比,不仅有更高的敏感性和特异性,而且可显著提高对CAP患者发生临床严重事件的预测价值。

Objective To explore the independent factors related to clinical severe events in community acquired pneumonia patients and to find out a simple,effective and more accurate prediction method.Methods Consecutive patients admitted to our hospital from August 2018 to July 2019 were enrolled in this retrospective study.The endpoint was the occurrence of severe events defined as a condition as follows intensive care unit admission,the need for mechanical ventilation or vasoactive drugs,or 30-day mortality during hospitalization.The patients were divided into severe event group and non-severe event group,and general clinical data were compared between two groups.Multivariate logistic regression analysis was performed to identify the independent predictors of adverse outcomes.Receiver operating characteristic(ROC)curve was constructed to calculate and compare the area under curve(AUC)of different prediction methods.Results A total of 410 patients were enrolled,96(23.4%)of whom experienced clinical severe events.Age(OR:1.035,95%CI:1.012-1.059,P=0.003),high-density lipoprotein(OR:0.266,95%CI:0.088-0.802,P=0.019)and lactate dehydrogenase(OR:1.006,95%CI:1.004-1.059,P<0.001)levels on admission were independent factors associated with clinical severe events in CAP patients.The AUCs in the prediction of clinical severe events were0.744(95%CI:0.699-0.785,P=0.028)and 0.814(95%CI:0.772-0.850,P=0.025)for CURB65 and PSI respectively.CURB65-LH,combining CURB65,HDL and LDH simultaneously,had the largest AUC of 0.843(95%CI:0.804-0.876,P=0.022)among these prediction methods and its sensitivity(69.8%)and specificity(81.5%)were higher than that of CURB65(61.5%and 76.1%)respectively.Conclusion CURB65-LH is a simple,effective and more accurate prediction method of clinical severe events in CAP patients,which not only has higher sensitivity and specificity,but also significantly improves the predictive value when compared with CURB65.