A-DROP评分对老年社区获得性肺炎临床结局的预测价值

Mortality prediction of A-DROP for elderly patients with community-acquired pneumonia

目的探讨A-DROP评分对老年社区获得性肺炎临床结局的预测价值。方法回顾性分析2019年1月~2020年12月本院呼吸与危重症医学科收治的老年社区获得性肺炎患者(CAP)临床资料,入院后24 h内完成血常规、生化等检测,并完成A-DROP、PSI、CURB-65评分,根据28 d结局分为死亡及存活组,通过比较受试者工作特征曲线(ROC)分析A-DROP、PSI、CURB-65对患者28 d死亡率的预测效能。结果共纳入137例老年CAP患者,其中死亡组23例,存活组114例,A-DROP、PSI、CURB-65评分在死亡组中更高(P<0.0001);A-DROP、CURB-65、PSI危险分层预测老年CAP患者28 d死亡率的AUC值分别为0.759、0.732、0.755,A-DROP的截断值为极严重组,其敏感性为82.61%,特异性为65.79%;依据A-DROP进行危险分层,极严重组患者中位生存时间为22.638天(95%CI:20.096~25.180),极严重组患者死亡风险是中度组患者8.56倍(95%CI 3.3~22.21),是严重组患者的4.28倍(95%CI:1.32~13.9)。结论A-DROP评分系统对老年CAP患者死亡率具有一定预测价值,与PSI、CURB-65的预测效能相当。

Objective To explore the value of A-DROP for the prognosis of elderly patients with community-acquired pneumonia(CAP).Methods The clinical data of patients admitted to Department of Respiratory and Critical Care Medicine of Karamay Central Hospital from January 2019 to December 2020 were retrospectively analyzed.The clinical parameters,biochemical data,A-DROP,PSI and CURB-65 were reviewed.The patients were grouped into survival and death group according to 28-day outcomes.Use ROC curve to estimate the predictive value of A-DROP,PSI,CURB-65.Results Among 137 elderly patients,114 survived in 28 days and 423 died,A-DROP,PSI,CURB-65 score were higher in died group than survived(P<0.0001).The AUC for 28day mortality for A-DROP,CURB-65,PSI scoring system were 0.759,0.732,0.755.The sensitivity was 82.61%,and specificity was 65.79%for 28day mortality of class extremely severe according to A-DROP.Median survival time was 22.638 day(95%CI:20.096-25.180)in class extremely severe.Class extremely severe was associated with 8.56 fold(95%CI 3.3-22.21)increase in mortality over class severe,and 4.28 fold over class severe(95%CI:1.32-13.9).Conclusion A-DROP scoring system is comparable in predictive value for 28day mortality in elderly patients with pneumonia to PSI and CURB-65.