摘要
目的探讨快速序贯器官衰竭(qSOFA)、微型营养评估法(MNA)评分联合血清降钙素原(PCT)对老年重症社区获得性肺炎(SCAP)患者预后的预测价值。方法回顾性分析2018年4月至2020年4月于中南大学湘雅医学院附属海口医院收治的老年SCAP患者128例,随访4周,根据生存与死亡情况分成生存组(n=110)和死亡组(n=18)。比较2组入院第1、3、7天的qSOFA、MNA、英国胸科协会改良肺炎评分(CURB-65)、肺炎严重指数(PSI)评分及血清PCT水平。绘制受试者工作特征(ROC)曲线分析qSOFA、MNA、CURB-65、PSI评分与血清PCT预测预后的曲线下面积(AUC),并分析预后危险因素。采用SPSS 20.0软件进行数据分析。根据数据类型,组间比较分别采用χ^(2)检验或者t检验。结果生存组第1、3、7天的qSOFA评分、血清PCT均较死亡组明显降低,且1周的qSOFA评分、血清PCT均值较死亡组明显降低(P<0.05)。生存组第1、3、7天的MNA评分较死亡组显著增高,且1周的MNA评分均值较死亡组明显增高(P<0.05)。生存组第1、3、7天的CURB-65、PSI评分低于死亡组(P<0.05)。血清PCT与qSOFA评分呈正相关(r=0.812,P<0.05),与MNA评分呈负相关(r=-0.785,P<0.05)。qSOFA、MNA评分及血清PCT单独与联合评估患者预后的AUC分别为0.712、0.705、0.722、0.862,CURB-65、PSI评分评估预后的AUC分别为0.702、0.698。Cox回归性分析显示住院时间、呼吸性酸中毒、有创机械通气、qSOFA评分、血清PCT增高和MNA评分降低是预后危险因素(P<0.05)。结论qSOFA、MNA评分联合血清PCT能对老年SCAP患者的预后进行预测。
Objective To explore the predictive value of quick sequential organ failure assessment(qSOFA)score,mini-nutrtional assessment(MNA)score combined with serum procalcitonin(PCT)level in the prognosis of elderly patients with severe community-acquired pneumonia(SCAP).Methods Clinical data of 128 elderly SCAP patients admitted to our hospital from April 2018 to April 2020 were collected and retrospectively analyzed.After follow-up for 4 weeks,the patients were divided into survival group(n=110)and death group(n=18).The scores of qSOFA,MNA,pneumonia severity index(PSI)and Confusion-Uremia-Respiratory rate,Blood pressure and age≥65 years(CURB-65),and the serum level of PCT were compared on the 1st,3rd,and 7th days after admission between the 2 groups.Receiver operating characteristic(ROC)curve was plotted to analyze the area under the ROC curve(AUC)of qSOFA,MNA,CURB-65 and PSI scores and serum PCT level to analyze the risk factors for prognosis.SPSS statistics 20.0 was used for statistical analysis.Student′s t test or Chi-square test was employed for intergroup comparison on different data types.Results The qSOFA score and serum PCT on the 1st,3rd,and 7th days were significantly lower in the survival group than the death group,and their average values at 1 week were obviously lower than those of the death group(P<0.05).The survival group had significantly higher MNA scores on the 1st,3rd,and 7th days than the death group,so was the average MNA score at 1 week(P<0.05).The scores of CURB-65 and PSI in the survival group on the 1st,3rd and 7th days were lower than those in the death group(P<0.05).The serum PCT level was positively correlated with qSOFA score(r=0.812,P<0.05),and negatively with MNA score(r=-0.785,P<0.05).The prognostic AUCs of qSOFA score,MNA score and serum PCT alone,and combined together were 0.712,0.705,0.722,and 0.862,respectively,and those of CURB-65 and PSI scores were 0.702 and 0.698,respectively.Cox regression analysis showed that length of hospital stay,respiratory acidosis,invasive mechanical ventilation,increased qSOFA score and serum PCT level,and decreased MNA score were risk factors affecting the prognosis of patients(P<0.05).Conclusion qSOFA and MNA scores combined with serum PCT level can be used to predict the prognosis of elderly SCAP patients.
作者
吴玉丹
吴美景
陈英诗
游英玉
符琼娥
WU Yu-Dan;WU Mei-Jing;CHEN Ying-Shi;YOU Ying-Yu;FU Qiong-E(Department of Respiratory and Critical Care Medicine,Haikou Hospital Affiliated to Central South University Xiangya School of Medicine,Haikou 570208,China)
出处
《中华老年多器官疾病杂志》
2021年第7期488-493,共6页
Chinese Journal of Multiple Organ Diseases in the Elderly
基金
海南省自然科学基金(818MS136)。
关键词
预后
重症社区获得性肺炎
快速序贯器官衰竭评分
微型营养评估法
降钙素原
prognosis
severe community-acquired pneumonia
quick sequential organ failure assessment
mini-nutrtional assessment
procalcitonin
