入院时血乳酸水平联合重症评分对社区获得性肺炎患者预后的评估价值

被引：21

作者：

史茹梦 ^{[1
]}

祝亭亭 ^{[1
]}

于凤颖 ^{[2
]}

刘思亮 ^{[1
]}

梁璐 ^{[2
]}

杨伟红 ^{[2
]}

机构：

[1] 河北大学医学院

[2] 河北大学附属医院

来源：

内科急危重症杂志 | 2019年 / 25卷 / 03期

关键词：

社区获得性肺炎; 快速脓毒症相关器官衰竭评分; 乳酸;

D O I：

暂无

中图分类号：

R563.1 [肺炎];

学科分类号：

100201 [内科学];

摘要：

目的:探讨入院时血乳酸水平联合快速脓毒症相关器官衰竭评分(qSOFA)、CRB/CURB-65评分对社区获得性肺炎(CAP)患者预后的评估价值。方法:回顾性收集入院8 h内有测定乳酸的512例CAP患者,均计算每例患者qSOFA、CRB/CURB-65评分,用受试者操作特性曲线(ROC曲线)评估各指标对不良预后(气管插管机械通气或需要血管加压素及住院期间死亡)的预测价值,并确定最佳截断值,行logistic回归确定不良预后的独立危险因素。结果:3个评分系统均显示得分越高,发生不良预后的几率越高:qSOFA(19.4%、45.5%、50%),CRB-65(10.7%、45.2%、66.7%),CURB-65(11.1%、23.5%、47.6%、100%),其中CURB-65(0.791、95%CI 0.707～0.876)对CAP患者不良预后具有最高的预测价值,联合血乳酸水平后CRB-65(0.761～0.795)、CURB-65(0.791～0.835)和qSOFA(0.770～0.837)评分的预测效能提高,qSOFA评分提高最明显。结论:单独CURB-65评分对住院CAP患者短期不良结局的预测价值优于qSOFA和CRB-65评分,但联合血乳酸水平后qSOFA评分具有更大的效力,对重症患者的检出可能更有利。

引用

页码：198 / 201

页数：4

共 10 条

[1]

老年脓毒症患者预后相关因素的探讨 [J].

王旭涛 ;

陈燕启 .

内科急危重症杂志, 2017, 23 (01) :23-25

[2]

社区获得性肺炎诊断和治疗指南.[J]..中华结核和呼吸杂志.2006, 10

[3]

Admission lactate predicts poor prognosis independently of the CRB/CURB-65 scores in community-acquired pneumonia [J].

Frenzen, F. S. ;

Kutschan, U. ;

Meiswinkel, N. ;

Schulte-Hubbert, B. ;

Ewig, S. ;

Kolditz, M. .

CLINICAL MICROBIOLOGY AND INFECTION, 2018, 24 (03) :306.e1-306.e6

[4]

Lactate levels and pneumonia severity index are good predictors of in-hospital mortality in pneumonia [J].

Demirel, Bulut .

CLINICAL RESPIRATORY JOURNAL, 2018, 12 (03) :991-995

[5]

Severity scoring systems for pneumonia: current understanding and next steps.[J].Otavio T. Ranzani;Leandro Utino Taniguchi;Antoni Torres.Current Opinion in Pulmonary Medicine.2018,

[6]

Antibiotic therapy prior to hospital admission is associated with reduced septic shock and need for mechanical ventilation in patients with community-acquired pneumonia [J].

Amaro, Rosanel ;

Sellares, Jacobo ;

Polverino, Eva ;

Cilloniz, Catia ;

Ferrer, Miquel ;

Fernandez-Barat, Laia ;

Mensa, Josep ;

Niederman, Michael S. ;

Torres, Antoni .

JOURNAL OF INFECTION, 2017, 74 (05) :442-449

[7]

Management of Adult Community-acquired Pneumonia and Prevention – Update 2016.[J].S. Ewig;G. H?ffken;W. Kern;G. Rohde;H. Flick;R. Krause;S. Ott;T. Bauer;K. Dalhoff;S. Gatermann;M. Kolditz;S. Krüger;J. Lorenz;M. Pletz;A. de Roux;B. Schaaf;T. Schaberg;H. Schütte;T. Welte.Pneumologie.2016, 03

[8]

Validation of modified early warning score using serum lactate level in community-acquired pneumonia patients. The National Early Warning Score–Lactate score.[J].Sion Jo;Taeoh Jeong;Jae Baek Lee;Youngho Jin;Jaechol Yoon;Boyoung Park.American Journal of Emergency Medicine.2016, 3

[9]

Initial serum lactate level is associated with inpatient mortality in patients with community-acquired pneumonia [J].

Gwak, Min Hyuk ;

Jo, Sion ;

Jeong, Taeoh ;

Lee, Jae Baek ;

Jin, Young Ho ;

Yoon, Jaechol ;

Park, Boyoung .

AMERICAN JOURNAL OF EMERGENCY MEDICINE, 2015, 33 (05) :685-690

[10]

Guidelines for the management of adult lower respiratory tract infections - Summary.[J].M. Woodhead;F. Blasi;S. Ewig;J. Garau;G. Huchon;M. Ieven;A. Ortqvist;T. Schaberg;A. Torres;G. van der Heijden;R. Read;T.J.M. Verheij.Clinical Microbiology and Infection.2011, S6

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