Prospective comparison of three predictive rules for assessing severity of community-acquired pneumonia in Hong Kong
Prospective comparison of three predictive rules for assessing severity of community-acquired pneumonia in Hong Kong
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DOI：
10.1136/thx.2006.069740
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发表时间：
2007-04-01
期刊：
影响因子：
10
通讯作者：
Rainer, Timothy H.
中科院分区：
文献类型：
--
作者：
Man, Shin Yan;Lee, Nelson;Rainer, Timothy H.
背景：社区获得性肺炎(CAP)是包括香港在内的全球主要感染性死亡原因。目的：比较2 0可变肺炎严重指数(PSI)、英国胸科学会采用的6分CURB65和更简单的CRB65 3种社区获得性肺炎(CAP)预测香港死亡率的能力。方法：2004年在香港新界一所大学医院对1016例CAP住院患者(男性583人，平均年龄72(17)岁)进行前瞻性观察研究。根据每个规则将患者分为三个风险组(低、中、高)。结果：总死亡率和ICU住院率分别为8.6%和4.0%。受试者工作特征曲线下面积分别为0.736(95%可信区间0.687~0.736)、0.733(95%可信区间0.679~0.787)和0.694(95%可信区间0.634~0.753)。在所有截断点，这三条规则都有较高的负面预测值，但相对较低的正面预测值。PSI(47.2%)和CURB65(43.3%)诊断为低风险的患者比例高于CRB65(12.6%)。结论：三种预测规则在预测CAP严重程度方面具有相似的性能，但CURB65更适合于急诊科使用，因为它应用简单，能够识别低风险患者。
Background: Community-acquired pneumonia (CAP) is a leading infectious cause of death throughout the world, including Hong Kong.Aim: To compare the ability of three validated prediction rules for CAP to predict mortality in Hong Kong: the 20 variable Pneumonia Severity Index (PSI), the 6-point CURB65 scale adopted by the British Thoracic Society and the simpler CRB65.Methods: A prospective observational study of 1016 consecutive inpatients with CAP (583 men, mean (SD) age 72 (17) years) was performed in a university hospital in the New Territories of Hong Kong in 2004. The patients were classified into three risk groups (low, intermediate and high) according to each rule. The ability of the three rules to predict 30 day mortality was compared.Results: The overall mortality and intensive care unit (ICU) admission rates were 8.6% and 4.0%, respectively. PSI, CURB65 and CRB65 performed similarly, and the areas under the receiver operating characteristic (ROC) curve were 0.736 (95% CI 0.687 to 0.736), 0.733 (95% CI 0.679 to 0.787) and 0.694 (95% CI 0.634 to 0.753), respectively. All three rules had high negative predictive values but relatively low positive predictive values at all cut-off points. Larger proportions of patients were identified as low risk by PSI (47.2%) and CURB65 (43.3%) than by CRB65 (12.6%).Conclusion: All three predictive rules have a similar performance in predicting the severity of CAP, but CURB65 is more suitable than the other two for use in the emergency department because of its simplicity of application and ability to identify low-risk patients.