不同评分系统对老年社区获得性肺炎患者转入ICU和死亡率的预测效能比较

Comparison of the value of different scoring systems in predicting the transfer of elderly community-acquired pneumonia patients to ICU and mortality

目的 比较不同评分系统预测老年社区获得性肺炎患者转入ICU和病死率的价值。方法 回顾性分析2020年1月到2023年7月的老年肺炎患者203例,收集患者临床资料。使用快速顺序器官功能衰竭评分(qSOFA)、CURB-65评分、国家预警评分(NEWS)和改良预警评分(MEWS)进行评估,评价不同评分工具对患者转入ICU和病死率的预测价值。结果 203例老年肺炎患者转入ICU46例(22.66%),死亡32例(15.76%)。较高的PCT、CURB-65和MWES是患者死亡的危险因素,较高的Alb是患者死亡的保护因素;较高的NEWS得分是患者转入ICU的危险因素,较高的Alb和PLT是患者转入ICU的保护因素。CURB-65、MEWS、NEWS和qSOFA预测病死率的临界值分别为3分、4分、5分和1分,预测转入ICU的临界值分别为2分、4分、7分和1分,其中MEWS预测病死率的AUC最高,为0.795,NEWS预测转入ICU的AUC最高,为0.841。结论 MEWS在预测老年肺炎患者住院病死率方面优于qSOFA、NEWS和CURB-65评分,而NEWS在预测转入ICU方面优于其他评分。

Objective To compare the value of different scoring systems in predicting the transfer and mortality of elderly community-acquired pneumonia patients to ICU.Methods A retrospective analysis was conducted on 203 elderly patients with pneumonia from January 2020 to July 2023,and their clinical data was collected.The predictive value of different scoring tools for patient transfer to ICU and mortality was evaluated using the Quick Order Organ Failure Score(qSOFA),CURB-65 score,National Early Warning Score(NEWS),and Modified Early Warning Score(MEWS).Results 203 elderly pneumonia patients were transferred to ICU,with 46 cases(22.66%)and 32 death(15.76%).Higher PCT,CURB-65,and MWES were risk factors for patient mortality,while higher Alb was a protective factor for patient mortality.A higher NEWS score was a risk factor for patients transferring to ICU,while higher Alb and PLT were protective factors for patients transferring to ICU.The critical values for predicting mortality using CURB-65,MEWS,NEWS,and qSOFA were 3 points,4 points,5 points,and 1 point,respectively.The critical values for predicting ICU transfer were 2 points,4 points,7 points,and 1 point,respectively.Among them,MEWS predicted the highest AUC for mortality at 0.795,while NEWS predicted the highest AUC for ICU transfer at 0.841.Conclusion MEWS is superior to qSOFA,NEWS,and CURB-65 scores in predicting hospitalization mortality in elderly pneumonia patients,while NEWS is superior to other scores in predicting ICU transfer.