Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study
Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study
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DOI：
10.1136/thorax.58.5.377
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发表时间：
2003-05-01
期刊：
影响因子：
10
通讯作者：
Macfarlane, JT
中科院分区：
文献类型：
--
作者：
Lim, WS;van der Eerden, MM;Macfarlane, JT
背景资料：在评估社区获得性肺炎（CAP）的严重程度时，修订的英国胸科学会（mBTS）规则确定了重度肺炎患者，但不确定可能适合家庭管理的患者。一个多中心的研究进行了推导和验证一个实用的严重程度评估模型分层成人住院与CAP到不同的管理groups.Methods：数据从三个前瞻性研究CAP在英国，新西兰和荷兰进行了合并。使用包含80%数据的衍生队列来开发模型。预后变量采用多元逻辑回归确定，30天死亡率作为结局指标。结果：研究了1068例患者（平均年龄64岁，51.5%男性，30天死亡率9%）。年龄大于或等于65岁（OR 3.5，95% CI 1.6 - 8.0）和白蛋白< 30 g/dl（OR 4.7，95% CI 2.5 - 8.7）与高于mBTS规则（OR 5.2，95% CI 2.7 - 10）的死亡率独立相关。6分，意识模糊、尿素> 7 mmol/l、呼吸频率大于或等于30/min、低收缩压各1分（< 90 mm Hg）或舒张压（≥ 65岁（CURB- 65评分），基于初始医院评估时可用的信息，使患者能够根据死亡风险增加进行分层：评分0，0.7%;评分1，3.2%; 2分，3%; 3分，占17%; 4分者占41.5%，5分者占57%。验证队列证实了类似的pattern.Conclusions：一个简单的六点评分的基础上混乱，尿素，呼吸频率，血压，和年龄可以用来分层与CAP患者到不同的管理组。
Background: In the assessment of severity in community acquired pneumonia ( CAP), the modified British Thoracic Society (mBTS) rule identifies patients with severe pneumonia but not patients who might be suitable for home management. A multicentre study was conducted to derive and validate a practical severity assessment model for stratifying adults hospitalised with CAP into different management groups.Methods: Data from three prospective studies of CAP conducted in the UK, New Zealand, and the Netherlands were combined. A derivation cohort comprising 80% of the data was used to develop the model. Prognostic variables were identified using multiple logistic regression with 30 day mortality as the outcome measure. The final model was tested against the validation cohort.Results: 1068 patients were studied ( mean age 64 years, 51.5% male, 30 day mortality 9%). Age greater than or equal to 65 years ( OR 3.5, 95% CI 1.6 to 8.0) and albumin < 30 g/dl ( OR 4.7, 95% CI 2.5 to 8.7) were independently associated with mortality over and above the mBTS rule ( OR 5.2, 95% CI 2.7 to 10). A six point score, one point for each of Confusion, Urea > 7 mmol/l, Respiratory rate greater than or equal to30/min, low systolic(< 90 mm Hg) or diastolic (= 65 years ( CURB- 65 score) based on information available at initial hospital assessment, enabled patients to be stratified according to increasing risk of mortality: score 0, 0.7%; score 1, 3.2%; score 2, 3%; score 3, 17%; score 4, 41.5% and score 5, 57%. The validation cohort confirmed a similar pattern.Conclusions: A simple six point score based on confusion, urea, respiratory rate, blood pressure, and age can be used to stratify patients with CAP into different management groups.