优化快速序贯器官衰竭评估评分对社区获得性肺炎严重程度及预后的研究分析

Effect of qSOFA score on severity and prognosis of community acquired pneumonia

目的应用快速序贯器官衰竭评估(qSOFA)评分、英国胸科协会改良肺炎(CURB-65)评分对社区获得性肺炎(CAP)严重程度及预后预测价值分析。方法回顾性收集2021年4月~2022年6月河北省第七人民医院呼吸内科收治的CAP患者180例,根据治疗结局分为死亡组(n=30)和存活组(n=150);根据2016年中国成人社区获得性肺炎的诊断、分级标准分为重症组(n=80)和非重症组(n=100)。以死亡和重症为主要的不良结局,采用ROC曲线分析qSOFA评分、CURB-65评分对疾病严重程度及预后预测价值。结果死亡组与存活组患者年龄、呼吸频率、收缩压、血乳酸、qSOFA评分、CURB-65评分差异具有统计学意义(P<0.05);重症组与非重症组患者年龄、呼吸频率、收缩压、血乳酸、qSOFA评分、CURB-65评分差异具有统计学意义(P<0.05)。重症CAP患者CURB-65评分的灵敏度为70.31%,特异度为83.25%,qSOFA评分灵敏度为58.14%,特异度为89.80%,Age-Lac-qSOFA评分灵敏度为97.15%,特异度为79.88%;死亡患者CURB-65评分的灵敏度为38.15%,特异度为83.25%,qSOFA评分灵敏度为49.80%,特异度为92.0%,Age-Lac-qSOFA评分灵敏度为91.53%,特异度为83.45%,Age-Lac-qSOFA评分预测较高。结论qSOFA评分、CURB-65评分对CAP重症与死亡具有较高的预测价值,但对qSOFA评分进行优化后,Age-Lac-qSOFA评分的预测价值更高。

Objective To analyze the predictive value of qSOFA score and CURB-65 score in assessing the severity and prognosis of community acquired pneumonia(CAP).Methods 180 patients with community or acquired pneumonia admitted in the respiratory department of our hospital from April 2021 to June 2022 were retrospectively collected.According to the treatment outcome,they were divided into death group(n=30)and survival group(n=150).According to the diagnosis and grading criteria of adult community-acquired pneumonia in China in 2016,they were divided into severe group(n=80)and non severe group(n=100).The main adverse outcomes were death and severe.The predictive value of qSOFA score and CURB-65 score on disease severity and prognosis was analyzed by ROC curve.Results There were statistically significant differences in age,respiratory rate,systolic blood pressure,blood lactic acid,qSOFA score and CURB-65 score between the death group and the survival group(P<0.05).There were statistically significant differences in age,respiratory rate,systolic blood pressure,blood lactic acid,qSOFA score and CURB-65 score between the severe group and the non severe group(P<0.05).In severe CAP,the sensitivity of CURB-65 score was 70.31%,specificity was 83.25%,the sensitivity of qSOFA score was 58.14%,specificity was 89.80%,the sensitivity of Age Lac qSOFA score was 97.15%,specificity was 79.88%,the sensitivity of Age qSOFA score was 98.05%,specificity was 29.82%,the sensitivity of Lac qSOFA score was 82.16%,specificity was 62.27%.In death,the sensitivity of CURB-65 score was 38.15%,the specificity was 83.25%,the sensitivity of qSOFA score was 49.80%,the specificity was 92.0%,the sensitivity of Age Lac qSOFA score was 91.53%,the specificity was 83.45%,the sensitivity of Age qSOFA score was 82.12%,the specificity was 39.42%,and the sensitivity of Lac qSOFA score was 96.26%,the specificity was 36.15%.The prediction ability of Age qSOFA score and Lac qSOFA score is low,while that of Age Lac qSOFA score is high.Conclusion qSOFA score and CURB-65 score have high predictive value for severe cases and death of CAP,but after optimizing qSOFA score,Age Lac qSOFA score has high predictive value.