基于临床特征的MuLBSTA评分对病毒性肺炎预后的评估价值

Prognostic value of MuLBSTA score based on clinical characteristics for viral pneumonia

目的评估基于临床特征的MuLBSTA评分对病毒性肺炎预后的评估价值。方法回顾性分析2013年1月1日至2022年12月31日间于福建省福州肺科医院出院、确诊为病毒性肺炎的患者,分别进行肺炎严重指数(PSI)、CURB-65(C代表意识,U代表血尿素氮,R代表呼吸频率,B代表血压,65代表年龄)和MuLBSTA评分,比较不同评分分级患者入住ICU和病死的差异,绘制相应的受试者操作特征曲线(ROC)分析3个评分对病死的预测价值。采用方差分析、秩和检验、χ^(2)检验。结果入组137例患者,其中男88例,女49例,年龄19~93岁;新型冠状病毒肺炎69例、甲型流感病毒性肺炎50例、人感染H7N9禽流感肺炎18例;重症71例(51.82%),入住ICU 22例(16.06%),病死15例(10.95%)。对于入住ICU和病死的患者进行PSI、CURB-65和MuLBSTA评分严重程度分层分析,差异均有统计学意义(均P<0.05),评分危险程度越高,入住ICU和病死的比例越高。但只有CURB-65和MuLBSTA可预测病毒性肺炎患者病死率,其中MuLBSTA的曲线下面积为0.750,诊断灵敏度100.00%,准确度60.55%,cutoff值为7.5分。结论MuLBSTA评分可用于病毒性肺炎预后评估,简单易记,适合门诊和基层医院推广。

Objective To evaluate the prognostic value of MuLBSTA score based on clinical characteristics for viral pneumonia.Methods A retrospective analysis was conducted on patients who were discharged from Fuzhou Pulmonary Hospital of Fujian between January 1,2013 and December 31,2022 and were diagnosed as viral pneumonia.The Pneumonia Severity Index(PSI),CURB-65(C for consciousness,U for blood urea nitrogen,R for respiratory rate,B for blood pressure,65 for age),and MuLBSTA scores were calculated and stratified.The differences in ICU admission and mortality rate among patients with different grades were compared,and the corresponding receiver operating characteristic curve(ROC)was drawn to analyze the predictive values of the three scores to death.Analysis of variance,rank sum test,andχ^(2) test were used.Results A total of 137 patients were enrolled in this study,including 88 males and 49 females,aged 19-93 years.There were 69 cases of COVID-19,50 cases of influenza A viral pneumonia,18 cases of human infection with H7N9 avian influenza pneumonia,with 71 cases of severe illness(51.82%),22 cases(16.06%)admitted to ICU,and 15 cases of death(10.95%).The hierarchical analysis of PSI,CURB-65,and MuLBSTA scores for patients admitted to ICU and mortality rate showed that there were statistically significant differences(all P<0.05).The higher the risk of scoring,the higher the proportions of admission to ICU and death from illness.However,only CURB-65 and MuLBSTA scores predicted death in patients with viral pneumonia.The area under the curve of MuLBSTA was 0.750,the diagnostic specificity was 100.00%,the accuracy was 60.55%,and the cutoff value was 7.5.Conclusion The MuLBSTA score can be used for prognostic evaluation of viral pneumonia,which is simple and easy to memorize,and is suitable for promotion in outpatient and grassroots hospitals.