氧合指数对成人社区获得性肺炎患者临床结局的预测价值

The prediction of oxygenation index on clinical outcomes of adult community acquired pneumonia patients

目的探究成人社区获得性肺炎(CAP)患者氧合指数(P/F)对临床结局的预测价值。方法提取AHCCDM重症数据框中符合入组条件的CAP者493例,根据出院时是否存活分为生存组(n=405)和死亡组(n=88)单因素比较分析;多因素Logistic回归分析影响CAP患者住院死亡相关的独立危险因素;采用限制性立方样条曲线(RCS)评估P/F与住院死亡风险的变化趋势。结果多因素Logistic回归分析显示影响CAP患者住院死亡的独立危险因素包括:急性及慢性健康评分(ApacheⅡ评分)(OR=1.11,95%CI:1.07~1.15,P=0.02)、P/F(OR=1.70,95%CI:1.03~2.82,P=0.04),血红蛋白(Hb)和HCO-3浓度P>0.05差异无统计学意义;限制性立方样条回归分析显示:P/F与院内病死率呈非线性反应关系(非线性检验P<0.001),P/F为250 mmHg是住院死亡关联分析的切点。P/F<250 mmHg时,P/F每上升1 mmHg,住院死亡风险降低1%,HR:0.99(0.99~1.00),P<0.001;P/F>250 mmHg时CAP患者与住院病死率无关,HR:1.00(1.00~1.01),P<0.001,即其他因素占主导作用。结论明显降低的P/F对于社区获得性肺炎患者具有较高的死亡预测价值。

Objective To explore the predictive value of oxygenation index(P/F)for clinical outcomes in adult community acquired pneumonia(CAP)patients.Methods 493 patients with CAP eligible for inclusion were extracted from AHCCDM,and were divided into survival group(n=405)and death group(n=88)according to whether they survived at discharge;multivariate Logistic regression analysis was used to identify independent risk factors associated with hospitalization death in CAP patients;the trend of changes in oxygenation index(P/F)and hospital mortality risk was evaluated using a restricted cubic spline(RCS)curve.Results Multivariate Logistic regression analysis found that independent risk factors affecting hospitalization death in CAP patients included acute and chronic health scores(Apache II score)(OR=1.11,95%CI:1.07-1.15,P=0.02),P/F(OR=1.70,95%CI:1.03-2.82,P=0.04),and hemoglobin(Hb)and HCO-3 concentration P>0.05,which were not statistically significant;restrictive cubic spline regression analysis found that there was a non-linear response relationship between P/F and hospital mortality(non-linear test P<0.001),and a P/F of 250 mmHg was the cutoff point for the hospital mortality association analysis.P/F<250 mmHg,for every 1 mmHg increased in P/F,the risk of in-hospital mortality was reduced by 1%,HR:0.99(0.99-1.00),P<0.001.P/F>250 mmHg,there was no association between CAP patients and in-hospital mortality,HR:1.00(1.00-1.01),P<0.001,indicating that other factors played a dominant role.Conclusion A significantly reduced P/F has a high predictive value for mortality in patients with community-acquired pneumonia.