CPIS评分对呼吸机相关性肺炎预后评价的ROC曲线研究

ROC Curve Study on the prognosis Evaluation of aspirationassociated Pneumonia by CPIS Score

目的探讨临床肺部感染评分(CPIS)对呼吸机相关性肺炎(VAP)预后的评估价值,并绘制受试者工作特征曲线(ROC)确定曲线下面积(AUC)与最佳界值。方法纳入南京市浦口区中医院2016年9月至2019年9月收治的VAP患者80例,均行有创机械通气。收集患者的临床资料,包括性别、年龄、通气体位、机械通气时间、ICU住院时间、抗菌药物应用种类、抗菌药物应用时间、气管切开、气管插管次数、口咽部细菌定植、基础病因。所有患者均于VAP确诊第1d、第5 d、转出前行CPIS评分,比较不同时段的CPIS评分。以VAP确诊第1 d的CPIS评分为依据,分析CPIS评分与患者临床特征的关系。根据患者住院期间的预后情况,分成死亡组、生存组,比较两组VAP确诊第1 d的CPIS评分,绘制ROC曲线分析其对VAP的预测价值。经Pearson线性相关分析VAP确诊第1 d的CPIS评分与临床特征间的相关性。结果80例VAP患者中,有15(18.75%)例死亡,65(81.25%)例存活,分别纳入死亡组、存活组。机械通气时间≥3 d、ICU住院时间≥7 d、气管插管>2次、口咽部非正常菌群定植患者VAP确诊第1 d的CPIS评分显著高于机械通气<3d、ICU住院<7 d、气管插管≤2次、口咽部非正常菌群定植的患者(P<0.05)。存活组VAP确诊第1 d、第5 d、转出前CPIS评分均显著低于死亡组(P<0.05)。VAP确诊第1 d的CPIS评分评价VAP患者预后的AUC为0.719(标准误=0.072,P=0.003,95%CI=0.578~0.861),最佳界值为6.610分,敏感度为70.00%,特异度为56.70%。VAP确诊第1 d的CPIS评分与机械通气时间、ICU住院时间、气管插管次数、口咽部菌群定植呈正相关(P<0.05)。结论VAP确诊第1 d的CPIS评分对VAP预后有一定预测价值,且其评分可能与机械通气时间、ICU住院时间、气管插管次数、口咽部菌群定植存在关联。

Objective To evaluate the prognostic value of clinical pulmonary infection score(CPIS)in patients with ventilator-associated pneumonia(VAP),and to determine the area under the curve(AUC)and the best cut-off value by drawing the receiver operating characteristic curve(ROC).Methods 80 VAP patients were admitted from September 2016 to September 2019 in Pukou District Hospital of traditional Chinese medicine in Nanjing,invasive mechanical ventilation was performed on all patients.The clinical data of patients were collected,it includes sex,age,position of ventilation,duration of mechanical ventilation,length of stay in ICU,types of antibiotics,duration of antibiotics,tracheotomy,number of tracheal intubation,bacterial colonization in oropharynx and underlying etiology.All patients were evaluated with CPIS on the 1 st,5 th day and before being transferred after VAP was diagnosed,CPIS scores at different time periods were compared.Based on the CPIS score on the 1 st day of VAP diagnosis,the relationship between CPIS score and clinical characteristics was analyzed.According to the prognosis of patients in hospital,the patients were divided into death group and survival group.The CPIS score on the 1 st day of VAP diagnosis was compared between the two groups,the ROC curve was drawn to analyze its predictive value for VAP.The correlation between CPIS score on the 1 st day of VAP diagnosis and clinical features was Analyzed by Pearson Linear Correlation.Results Among 80 VAP patients,15(18.75%)died and 65(81.25%)survived,they were divided into the death group and the survival group.The CPIS score of patients with more than 3 days of mechanical ventilation,more than 7 days of ICU stay,more than 2 times of tracheal intubation,and less than 3 days of mechanical ventilation,less than 7 days of ICU stay,less than 2 times of tracheal intubation and less than 1 day of oropharyngeal abnormal bacterial colonization were significantly higher than that of patients with less than 3 days of mechanical ventilation,less than 7 days of ICU stay,less than 2 times of tracheal intubation and less than 2 times of oropharyngeal abnormal bacterial colonization(P<0.05).The CPIS scores in the survival group were significantly lower than those in the death group(P<0.05)on the 1 st,5 th day of VAP diagnosis and before transfer.The AUC of VAP patients evaluated with CPIS score on the 1 st day of VAP diagnosis was 0.719(standard error=0.072,P=0.003,95%CI=0.578~0.861),the best cut-off value was 6.610,the sensitivity was 70.00%,and the specificity was 56.70%.The CPIS score on the 1 st day after VAP diagnosis was positively correlated with the duration of mechanical ventilation,the duration of ICU stay,the number of endotracheal intubation and the colonization of oropharyngeal flora(P<0.05).Conclusion CPIS score on the 1 st day of VAP diagnosis may have some predictive value for the prognosis of VAP,and it may be related to the duration of mechanical ventilation,ICU stay,the number of endotracheal intubation and the colonization of oropharynx flora.