重症肺炎胸部CT表现联合CPIS评分对预后的评估价值分析

Prognostic Value Of Chest CT Findings Combined with Cpis in Patients with Severe Pneumonia

目的分析胸部计算机断层扫描(CT)表现联合临床肺部感染评分(CPIS)评分对重症肺炎患者预后的评估价值。方法选取河南大学第一附属医院2021年1月至2023年1月ICU收治的86例重症肺炎患者。根据28 d的存活情况分为存活组和死亡组。所有患者入院后48h内完成胸部CT平扫,对影像学结果进行定量分析及视觉评分。采用CPIS评分量表评估患者肺部感染程度。收集患者性别、年龄、体质量指数(BMI)等临床资料。Logistic回归分析影响患者预后的危险因素。受试者操作特征曲线(ROC)分析胸部CT联合CPIS评分评估患者预后价值。结果86例重症肺炎患者入院28d内,有20患者死亡,死亡率为23.26%。死亡组入院白细胞计数、PCT、CRP、CPIS评分、CT评分、APACHEⅡ评分高于存活组(P<0.05)。Logistic回归显示,CPIS评分、APACHEⅡ评分、CT评分是影响患者不良预后危险因素(P<0.05),ROC曲线分析显示,CPIS评分、CT评分及联合检测评估患者不良曲线下面积(AUC)分别为0.719,0.746,0.892,P<0.05。结论CT评分联合CPIS评分评估重症肺炎患者预后具有较好效能。

Objective To analyze the prognostic value of chest computed tomography(CT)findings combined with clinical pulmonary infection score(CPIS)in patients with severe pneumonia.Methods A total of 86 patients with severe pneumonia admitted to ICU of the First Affiliated Hospital of Henan University were enrolled between January 2021 and January 2023.According to 28d survival,they were divided into survival group and death group.All patients underwent chest CT plain scan within 48h after admission,and imaging findings of chest CT were quantitatively analyzed and visually scored.The severity of pulmonary infection was evaluated by CPIS.The clinical data of patients were collected,including gender,age and body mass index(BMI).The risk factors of prognosis in patients with severe pneumonia were analyzed by Logistic regression analysis.The prognostic value of chest CT combined with CPIS in patients with severe pneumonia was evaluated by receiver operating characteristic(ROC)curves.Results In the 86 patients with severe pneumonia within 28d after admission,there were 20 death cases(23.26%).The white blood cell count,PCT,CRP,CPIS,CT score and APACHE II score in death group were higher than those in survival group(P<0.05).Logistic regression showed that CPIS score,APACHEⅡscore,and CT score were risk factors for poor prognosis(P<0.05).ROC curves analysis showed that area under the curve(AUC)values of CPIS,CT score and combined detection for evaluating prognosis were 0.719,0.746 and 0.892,respectively(P<0.05).Conclusion CT score combined with CPIS has better evaluation efficiency for prognosis of patients with severe pneumonia.