Prospective comparison of three validated prediction rules for prognosis in community-acquired pneumonia
Prospective comparison of three validated prediction rules for prognosis in community-acquired pneumonia
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DOI：
10.1016/j.amjmed.2005.01.006
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发表时间：
2005-04-01
影响因子：
5.9
通讯作者：
Fine, MJ
中科院分区：
文献类型：
--
作者：
Aujesky, D;Auble, TE;Fine, MJ
目的：我们评估了3种有效的预测社区获得性肺炎30天死亡率的预后规则的性能：20变量肺炎严重程度指数和更容易计算的CURB（意识混乱、尿素氮、呼吸频率、血压）和CURB-65严重程度评分。研究对象和方法：我们前瞻性随访了来自32家医院急诊科的3181例社区获得性肺炎患者（2001年1月至12月），并评估了首次就诊后30天的死亡率。将患者分为肺炎严重程度指数风险等级（I-V）、CURB（0-4）和CURB-65（0-5）风险等级。我们比较了这些规则预测死亡率的区分能力（受试者工作特征曲线下的面积）及其基于敏感性、特异性、预测值和可能性比的准确性。结果：肺炎严重程度指数（风险等级I-III）将患者分类为低风险的比例（68%[2152/3181]）高于CURB评分< 1的比例（51%[1635/3181]）或CURB-65评分< 2的比例（61%[1952/3181]）。根据肺炎严重程度指数确定的低危患者的死亡率（1.4%[31/2152]）略低于根据CURB（1.7%[28/1635]）或CURB-65（1.7%[33/1952]）划分为低危的患者。肺炎严重程度指数（0.81）的受试者工作特征曲线下面积高于CURB（0.73）或CURB-65（0.76）评分（两两比较，P < 0.001）。在可比较的临界值上，肺炎严重程度指数比任何一种CURB评分具有更高的敏感性和更高的死亡率阴性预测值。结论：更复杂的肺炎严重程度指数对短期死亡率具有更高的判别能力，定义了更大比例的低风险患者，并且在识别低风险患者方面比任何一种抑制评分都更准确。(c) 2005爱思唯尔公司版权所有。
PURPOSE: We assessed the performance of 3 validated prognostic rules in predicting 30-day mortality in community-acquired pneumonia: the 20 variable Pneumonia Severity Index and the easier to calculate CURB (confusion, urea nitrogen, respiratory rate, blood pressure) and CURB-65 severity scores.SUBJECTS AND METHODS: We prospectively followed 3181 patients with community-acquired pneumonia from 32 hospital emergency departments (January-December 2001) and assessed mortality 30 days after initial presentation. Patients were stratified into Pneumonia Severity Index risk classes (I-V) and CURB (0-4) and CURB-65 (0-5) risk strata. We compared the discriminatory power (area under the receiver operating characteristic curve) of these rules to predict mortality and their accuracy based on sensitivity, specificity, predictive values, and likelihood ratiosRESULTS: The Pneumonia Severity Index (risk classes I-III) classified a greater proportion of patients as low risk (68% [2152/3181]) than either a CURB score < 1 (51% [1635/3181]) or a CURB-65 score < 2 (61% [1952/3181]). Low-risk patients identified based on the Pneumonia Severity Index had a slightly lower mortality (1.4% [31/2152]) than patients classified as low-risk based on the CURB (1.7% [28/1635]) or the CURB-65 (1.7% [33/1952]). The area under the receiver operating characteristic curve was higher for the Pneumonia Severity Index (0.81) than for either the CURB (0.73) or CURB-65 (0.76) scores (P < 0.001, for each pairwise comparison). At comparable cut-points, the Pneumonia Severity Index had a higher sensitivity and a somewhat higher negative predictive value for mortality than either CURB score.CONCLUSIONS: The more complex Pneumonia Severity Index has a higher disciminatory power for short-term mortality, defines a greater proportion of patients at low risk, and is slightly more accurate in identifying patients at low risk than either CURB score. (c) 2005 Elsevier Inc. All rights reserved.