A validation and potential modification of the pneumonia severity index in elderly patients with community-acquired pneumonia
A validation and potential modification of the pneumonia severity index in elderly patients with community-acquired pneumonia
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DOI：
10.1111/j.1532-5415.2006.00825.x
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发表时间：
2006-08-01
影响因子：
6.3
通讯作者：
Nakamura, Hirotoshi
中科院分区：
文献类型：
--
作者：
Naito, Tateaki;Suda, Takafumi;Nakamura, Hirotoshi
目的：评价肺炎严重程度指数(PSI)在老年社区获得性肺炎(CAP)患者中的区分力，以提高其识别能力。设计：对1999~2001年193例老年社区获得性肺炎患者进行回顾性分析，以得出其预后规律。这些规则在2002年至2003年的144名患者中进行了前瞻性验证。设置：岩田市医院，一家拥有400张床位的综合医院。部分：80岁及以上患有CAP并入院的患者。测量：通过Logistic回归分析确定30天死亡率的预测因素，并结合PSI和独立预测因素构建几个规则。分类和回归树分析也被用于构建规则。结果：原PSI将W型和V型PSI定义为高危人群，在区分存活和死亡方面表现不佳(敏感度为100%，特异度为15%)，而改良PSI仅将V型PSI定义为高危组，其敏感度为86%，特异度为63%。三个独立于改良的PSI的死亡率预测因素被确定：功能状态(PS)3级或更高，厌食症，二氧化碳分压50毫米汞或更高。通过将改进的PSI和PS相结合，可以进一步提高性能(敏感度79%，特异度80%)。结论：改进的PSI能比原始PSI更准确地识别低危患者。此外，通过将改进的PSI与PS相结合，获得了更高的性能。这些信息将有助于医生的临床决策，而不会高估老年CAP患者的风险。
OBJECTIVES: To evaluate the discriminatory power of the Pneumonia Severity Index (PSI) in elderly patients with community-acquired pneumonia (CAP) and to improve its performance.DESIGN: Retrospective review of 193 patients from 1999 to 2001 to derive prognostic rules. The rules were prospectively validated in 144 patients from 2002 to 2003.SETTING: Iwata City Hospital, a 400-bed general hospital.PARTICIPANTS: Patients aged 80 and older who had CAP and were admitted to the hospital.MEASUREMENTS: Predictors of 30-day mortality were identified using logistic regression analysis, and several rules were constructed by combining the PSI and the independent predictors. Classification and regression tree analysis was also used for constructing rules. Sensitivity and specificity were calculated.RESULTS: The original PSI, which defines PSI Class Wand V as a high-risk group, did not perform well in discriminating survivors from nonsurvivors (sensitivity 100%, specificity 15%), whereas a modified PSI, which defines only PSI Class V as a high-risk group, performed better (sensitivity 86%, specificity 63%). Three predictors for mortality were identified independent from the modified PSI: performance status (PS) Grade 3 or higher, anorexia, and partial pressure of carbon dioxide of 50 mmHg or greater. By combining the modified PSI and PS, the performance could be further improved (sensitivity 79%, specificity 80%).CONCLUSION: The modified PSI could identify low-risk patients more accurately than the original PSI. In addition, by combining the modified PSI with PS, higher performance was obtained. Such information would aid physicians in clinical decision-making without overestimating the risk for elderly patients with CAP.