Clinical Features Predicting Mortality Risk in Patients With Viral Pneumonia: The MuLBSTA Score
Clinical Features Predicting Mortality Risk in Patients With Viral Pneumonia: The MuLBSTA Score
复制标题
预测病毒性肺炎患者死亡风险的临床特征：MuLBSTA 评分
DOI：
10.3389/fmicb.2019.02752
复制
发表时间：
2019-12-03
影响因子：
5.2
通讯作者：
Qu, Jieming
中科院分区：
文献类型：
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作者：
Guo, Lingxi;Wei, Dong;Qu, Jieming
目的进一步明确病毒性肺炎患者的临床特点，预测其死亡风险。方法选择2015年5月至2019年5月在上海瑞金医院就诊的病毒性肺炎患者528例。采用多重实时荧光RT-PCR方法检测呼吸道病毒。入院时收集人口学资料、合并症、常规实验室检查、免疫学指标、病原学检测、放射学影像和治疗。结果住院90天内死亡76例(14.4%)。在多因素Logistic回归模型的基础上计算了MULBSTA的预测性评分，以预测死亡率，加权评分包括多小叶浸润(OR=5.2，95%CI1.41-12.52，p=0.010；5分)、淋巴细胞≤0.8∗109/L(OR=4.53，95%CI2.55-8.05，p<；0.001；4分)、细菌合并感染(OR=3.71，95%CI2.11-6.51，p<；0.001；4分)、急性吸烟者(OR=3.19，95%CI1.34~6.26，p=0.001；3分)、戒烟(OR=2.18，95%CI0.99~4.82，p=0.054；2分)、高血压(OR=2.39，95%CI1.55~4.26，p=0.003；2分)、≥60岁(OR=2.14，95%CI1.04~4.39，p=0.038；2分)。以12分作为死亡危险分层的分界值。该模型的敏感度为0.776，特异度为0.778，预测能力优于CRIT-65(AUROC=0.773 vs.0.717，p<；0.001)。结论在这里，我们设计了一种简单易用的临床预测工具来评估病毒性肺炎90天的死亡风险。它可以准确地将病毒性肺炎住院患者划分为相关的风险类别，并可为进一步的临床决策提供指导。
Objective The aim of this study was to further clarify clinical characteristics and predict mortality risk among patients with viral pneumonia. Methods A total of 528 patients with viral pneumonia at RuiJin hospital in Shanghai from May 2015 to May 2019 were recruited. Multiplex real-time RT-PCR was used to detect respiratory viruses. Demographic information, comorbidities, routine laboratory examinations, immunological indexes, etiological detections, radiological images and treatment were collected on admission. Results 76 (14.4%) patients died within 90 days in hospital. A predictive MuLBSTA score was calculated on the basis of a multivariate logistic regression model in order to predict mortality with a weighted score that included multilobular infiltrates (OR = 5.20, 95% CI 1.41–12.52, p = 0.010; 5 points), lymphocyte ≤ 0.8∗109/L (OR = 4.53, 95% CI 2.55–8.05, p < 0.001; 4 points), bacterial coinfection (OR = 3.71, 95% CI 2.11–6.51, p < 0.001; 4 points), acute-smoker (OR = 3.19, 95% CI 1.34–6.26, p = 0.001; 3 points), quit-smoker (OR = 2.18, 95% CI 0.99–4.82, p = 0.054; 2 points), hypertension (OR = 2.39, 95% CI 1.55–4.26, p = 0.003; 2 points) and age ≥60 years (OR = 2.14, 95% CI 1.04–4.39, p = 0.038; 2 points). 12 points was used as a cut-off value for mortality risk stratification. This model showed sensitivity of 0.776, specificity of 0.778 and a better predictive ability than CURB-65 (AUROC = 0.773 vs. 0.717, p < 0.001). Conclusion Here, we designed an easy-to-use clinically predictive tool for assessing 90-day mortality risk of viral pneumonia. It can accurately stratify hospitalized patients with viral pneumonia into relevant risk categories and could provide guidance to make further clinical decisions.