入院时血乳酸水平联合重症评分对患者预后价值评估

目的：探讨入院时血乳酸水平联合qSOFA，CRB/CURB-65评分对社区获得性肺炎（CAP）患者预后的价值。方法：回顾性收集河北大学附属医院入院8小时内有测定乳酸的CAP患者，入选512例，每一例患者均计算qSOFA，CRB/CURB-65评分，用受试者操作特性曲线（ROC曲线）评估各指标对不良预后（气管插管机械通气或需要血管加压素及住院期间死亡）的预测价值，并确定最佳截断值，logistic回归用于确定不良预后的独立危险因素。结果：3个评分系统均显示得分越高，发生不良预后的比率越高：qSOFA（19.4%，45.5%，50%），CRB-65（10.7%，45.2%，66.7%），CURB-65（11.1%，23.5%，47.6%，100%），其中CURB-65（0.791，95%CI 0.707-0.876）对CAP患者不良预后具有最高的预测价值，加入乳酸后，CRB-65（0.761至0.795），CURB-65（0.791至0.835）和qSOFA（0.770至0.837）的预测效能提高，qSOFA评分提高最明显。结论：CURB-65虽单独对住院CAP患者发生院内死亡等短期不良结局预测优于qSOFA和CRB-65，但加入乳酸后qSOFA评分具有更大的效力，对重症患者的检出可能更有利。

Admission blood lactate level predicts prognosis combined with severe score in patients

Objective To explore the value of admission blood lactate level combined with qSOFA and CRB/CURB-65 scores in the assessment of prognosis for patients with community acquired pneumonia (CAP). Methods: 512 patients with community acquired pneumonia was enrolled in the study by retrospective collection blood lactate within 8 hours of admission in the Affiliated Hospital of Hebei University. The prognostic value was compared to the CRB/CURB-65 criteria by receiver operating characteristic (ROC) curve analysis and determining the cutoff value. The main endpoint was the combination of need for mechanical ventilation, vasopressors, or hospital mortality. Results: All three scoring systems showed higher scores have higher rates of poor prognosis: qSOFA (19.4%, 45.5%, 50%), CRB-65 (10.7%, 45.2%, 66.7%), CURB-65 ( 11.1%, 23.5%, 47.6%, 100%). CURB-65 (0.791, 95% CI 0.707-0.876) had the highest predictive value for poor prognosis in patients with CAP.After adding lactate, The predictive power of CRB-65 (0.761 to 0.795),CURB-65 (0.791 to 0.835)and qSOFA (0.770 to 0.837) was improved and qSOFA make a fortune. Conclusion: Although CURB-65 had the best predictive value for short-term poor prognosis compared to qSOFA and CRB-65 in patients with CAP,qSOFA score can be more effective after adding lactate, and may be have an impact on diagnosing critically ill patients.