GNRI、CPIS及炎症指标联合应用对老年社区获得性肺炎患者预后的预测价值

Prognostic value of GNRI,CPIS combined with inflammatory markers in elderly patients with community-acquired pneumonia

目的探讨老年人营养风险评分(GNRI)联合临床肺部感染评分(CPIS)及感染指标在老年社区获得性肺炎(CAP)患者中的预后评估价值。方法收集237例老年CAP住院患者,以GNRI 92分、CPIS 6分为界限,将患者分为GNRI<92分、CPIS≥6分组(A组,61例),GNRI<92分、CPIS<6分组(B组,65例),GNRI≥92分、CPIS≥6分组(C组,54例),GNRI≥92分、CPIS<6分组(D组,57例)。比较各组老年CAP患者的住院时间、机械通气率、住院期间病死率、年龄、吸烟史及基础疾病(高血压、冠状动脉粥样硬化性心脏病、2型糖尿病、肾功能不全)、入院时降钙素原(PCT)和CRP。采用受试者工作特征(ROC)曲线对比GNRI+CPIS和GNRI+CPIS联合CRP+PCT对老年CAP患者预后的预测价值。结果4组老年CAP患者的年龄、吸烟史、存在基础疾病及住院时间比较差异均无统计学意义(P均>0.05),4组的机械通气率、住院期间病死率、CRP、PCT比较差异均有统计学意义(P均<0.05)。GNRI+CPIS联合评分预测老年CAP患者死亡风险的ROC AUC为0.805、灵敏度为0.975、特异度为0.847;GNRI+CPIS联合CRP+PCT预测老年CAP患者住院期间死亡风险的ROC AUC为0.897,灵敏度为0.983,特异度为0.906;GNRI+CPIS联合CRP+PCT模型的预测价值高于GNRI+CPIS联合评分(P<0.001)。结论GNRI+CPIS联合CRP+PCT共同预测老年CAP住院期间病死率的价值高于GNRI+CPIS。

Objective To evaluate the prognostic value of geriatric nutritional risk index(GNRI)combined with clinical pulmonary infection score(CPIS)and inflammatory markers in elderly patients diagnosed with community-acquired pneumonia(CAP).Methods A total of 237 elderly patients with CAP were recruited and divided into the following 4 groups:GNRI<92 and CPIS≥6 group(A group,n=61),GNRI<92 and CPIS<6 group(B group,n=65),GNRI≥92 and CPIS≥6 group(C group,n=54)and GNRI≥92 and CPIS<6 group(D group,n=57)according to the limits of GNRI≥92 and CPIS≥6.The length of hospital stay,mechanical ventilation rate,mortality rate,age,smoking history and underlying diseases(hypertension,coronary atherosclerotic heart disease,type 2 diabetes mellitus and renal insufficiency),procalcitonin(PCT)and C-reactive protein(CRP)levels upon admission were statistically compared among different groups.The receiver operating characteristic(ROC)curve was delineated to compare the area under the ROC curve(AUC),sensitivity and specificity of GNRI+CPIS and GNRI+CPIS+CRP+PCT in predicting the clinical prognosis of CAP patients.Results Age,smoking history and underlying diseases and length of hospital stay did not significantly differ among the 4 groups(all P>0.05).The mechanical ventilation rate,mortality rate,CRP and PCT significantly differed among the 4 groups(all P<0.05).The area under curve(AUC),sensitivity and specificity of the combined score of GNRI+CPIS in predicting the risk of death in elderly patients with CAP was 0.805,0.975 and 0.847,respectively.The AUC,sensitivity and specificity of GNRI+CPIS+CRP+PCT in predict the risk of death in elderly patients with CAP was 0.897,0.983 and 0.906,respectively.The predictive value of the GNRI+CPIS+CRP+PCT model was significantly higher than that of the combined score of GNRI+CPIS(P<0.001).Conclusion Compared with GNRI+CPIS,GNRI+CPIS+CRP+PCT is more efficiency in predicting clinical prognosis of elderly patients with CAP.