Validation of the CORB75 (confusion,oxygen saturation,respiratory rate,blood pressure,and age ≥75 years) as a simpler pneumonia severity rule

Purpose

This study compares the ability of two simpler severity rules (classical CRB65 vs. proposed CORB75) in predicting short-term mortality in elderly patients with community-acquired pneumonia (CAP).

Methods

A population-based study was undertaken involving 610 patients ≥65 years old with radiographically confirmed CAP diagnosed between 2008 and 2011 in Tarragona, Spain (350 cases in the derivation cohort, 260 cases in the validation cohort). Severity rules were calculated at the time of diagnosis, and 30-day mortality was considered as the dependent variable. The area under the receiver operating characteristic curves (AUC) was used to compare the discriminative power of the severity rules.

Results

Eighty deaths (46 in the derivation and 34 in the validation cohorts) were observed, which gives a mortality rate of 13.1 % (15.6 % for hospitalized and 3.3 % for outpatient cases). After multivariable analyses, besides CRB (confusion, respiration rate ≥30/min, systolic blood pressure <90 mmHg or diastolic ≤60 mmHg), peripheral oxygen saturation (≤90 %) and age ≥75 years appeared to be associated with increasing 30-day mortality in the derivation cohort. The model showed adequate calibration for the derivation and validation cohorts. A modified CORB75 scoring system (similar to the classical CRB65, but adding oxygen saturation and increasing the age to 75 years) was constructed. The AUC statistics for predicting mortality in the derivation and validation cohorts were 0.79 and 0.82, respectively. In the derivation cohort, a CORB75 score ≥2 showed 78.3 % sensitivity and 65.5 % specificity for mortality (in the validation cohort, these were 82.4 and 71.7 %, respectively).

Conclusions

The proposed CORB75 scoring system has good discriminative power in predicting short-term mortality among elderly people with CAP, which supports its use for severity assessment of these patients in primary care.     

思考心电图之75

患者男性 ,２１岁。临床诊断 :病毒性心肌炎。该图的诊断是什么 ?有何依据 (请绘出Ｖ１ 导联梯形图 ) ?应与哪些心律失常相鉴别 ?思考心电图之75$山东省平阴县中医医院特检科@狄青华     

75岁以上组与75岁以下组急性心肌梗塞后果的比较

以某院2年内收治的连续994例病人为研究对象,A组307例的年龄大于75岁,B组687例的年龄≤75岁。A组同B组相比女性较多(56％对31％,P<0.01),束枝阻滞发生率较高(18％对5％,P<0.01),A组8％患者、B组36％患者符合溶栓指证,出血倾     

胰腺癌75例误诊分析

胰腺癌临床症状无特异性,易致误诊.现将1977年1月至1986年10月收治的,经病理学诊断或两项特殊检查(B 超、CT、ERCP、动脉造影),或手术加一项特殊检查而确诊胰腺癌患者141例,其中曾误为非胰腺癌诊断者75例,误诊率达53.7%报道如下.75例胰腺癌误诊情况:病毒性肝炎19例(25.3%),胃炎、溃疡病17例(22.7%),胰腺炎(其中有7例系在术中及/或病检而误诊)15例(20.0%),胆囊炎、胆石     

75岁以上的肺癌

在美国因癌肿死亡者肺癌居首位。1981年死于肺癌76 764人,其中有17 142人(占22％)≥75岁。作者复习了75岁以上(包括75岁,下同)肺癌的组织类型和转移形式,并与其它报告发生在所有年龄的肺癌作比较。美国新奥尔良退伍军人管理局医疗中心20年间     

窗流(75)

<正>心肌细胞动作电位的平台期由少量的内向和外向离子流精密维系,其来自多种离子通道,包括离子泵、交换器及电压门控通道。这些离子流的激活和失活过程的重叠部位形成窗流。     

肝破裂75例治疗体会

临床外伤中肝破裂常见,而且一旦发生往往病情危重。2003年2月-2007年12月我院收治外伤性肝破裂75例。现将诊治体会总结如下。     

早产儿75例护理体会

早产儿是指胎龄〉28周未满27周，出生体质量〈2500g，身长〈47cm的活产新生儿。由于各组织器官发育不成熟．生理功能低下，病死率是足月儿的10倍。2000年1～7月，我科共收治早产儿75例，现护理体会报告如下。     

P75NTR的研究进展

Ｐ７５＾ＮＴＲ是神经营养素的低亲和力受体，近年来研究认为砣具有逆行转输神经营养素选择相应的神经营养素、调节神经营养因子的酷氨酸激酶受体的信号传递和介导细胞凋亡等方面的功能。另外Ｐ７５＾ＭＴＲ与ＴｒＫＡ之间存在着相互抑制的关系。而且有人认为脑内Ｔｒｋｓ表达和功能异常及其与Ｐ７５＾ＮＴＲ的关系失衡可能对阿尔茨海默病的病理发展起重要的作用。     

Serum IL-6, TNFα, p55 srTNFα, p75 srTNFα, srIL-2α Levels and Disease Acitivity in Systemic Lupus Erythematosus

The aim of this study was to determine whether the levels of serum cytokines IL-6 and TNFα and of the soluble receptors p55 srTNFα, p75 srTNFα and srIL-2α are valuable markers of disease activity in patients with systemic lupus erythematosus (SLE) compared with the established parameters of anti-dsDNA, C3, C4 and CH₅₀. Forty patients with SLE, 19 ambulatory and 21 hospitalised, were included in this study. On the day of blood sampling a clinical examination was performed and SLEDAI and ECLAM disease activity scores were used to assess disease activity. Nineteen patients had inactive disease and 21 patients had active disease. Thirteen patients from the second group developed nephritis. In these patients the blood sampling and disease activity assessment were performed twice (at presentation and 6 months after treatment). Serum levels of cytokines and soluble receptors were measured by ELISA. Serum levels of cytokines and soluble receptors of patients with active disease were significantly higher than in patients with inactive disease (IL-6 p = 0.0004, TNFαp = 0.0015, srIL-2αp<0.0001, p55 srTNFαp<0.0001, p75 srTNFαp<0.0001). Serum soluble receptor levels of patients with inactive disease were higher than those of healthy controls (p55 srTNFαp<0.0001, p75 srTNFαp = 0.0002, srIL-2αp = 0.0012). No significant difference was found for TNFα and IL-6 (TNFαp = 0.015, IL-6 p = 0.019). Serum TNFα levels and especially srIL-2α, p55 srTNFα and p75 srTNFα levels correlated strongly with SLEDAI and ECLAM disease activity scores, anti-dsDNA, C3, C4 and CH₅₀ (p<0.0001). Serum soluble receptor (srIL-2α, p55 srTNFα, p75 srTNFα) levels were higher in patients with nephritis before treatment and decreased significantly 6 months after treatment (p = 0.005). The same trend was noticed with SLEDAI and ECLAM disease activity scores (p = 0.005) and anti-dsDNA (p = 0.008). In contrast, no significant differences were observed for C3 and C4 levels before and after treatment, which suggests that soluble receptors of cytokines are more sensitive markers of disease activity than C3 or C4 in predicting improvement. Serum levels of srIL-2α, p55 srTNFα and p75 srTNFα could provide useful information about disease activity in SLE patients, especially in cases where the other markers do not. Received: 3 March 1998 / Accepted: 13 July 1998     

缺血性结肠炎75例临床特征分析

背景:随着我国人口老龄化的加剧,缺血性结肠炎(IC)的发病率逐年增加。IC缺乏特异性临床表现,延迟诊断或误诊的发生率较高。目的:探讨IC的临床特征,提高其早期诊断和治疗水平。方法:回顾性分析2009年1月-2014年12月乌鲁木齐总医院75例IC患者的临床表现和内镜下特点。结果:IC多发生于60岁以上老年人,女性多于男性,多数患有高血压、冠心病、糖尿病、高脂血症、心律失常等基础疾病,结肠镜检查和药物亦可引起IC。临床表现主要为腹痛、便血和腹泻,病变主要位于左半结肠,发病类型以一过型IC最多见。结论:具有相关基础疾病的老年人出现腹痛、便血、腹泻表现者,应警惕IC可能,并尽早行结肠镜和病理检查。经及时治疗,IC预后良好。     

75例老年肺结核死亡分析

本文报告我院30年来60岁以上因肺结核住院死亡75例,其中男64例(85％),女11例(15％),男:女=5.8:1。分析表明,死亡原因以呼吸衰竭、心衰、全身衰竭多见。病型以Ⅲ型多见(72％),Ⅳ型次之(22％)。合并症共32种,以肺内感染为最多(62％),     

慢性盆腔炎75例治疗分析

<正>慢性盆腔炎是指女性内生殖器及其周围结缔组织、盆腔腹膜的慢性炎症。其主要临床表现为月经紊乱、白带增多、腰腹疼痛及不孕等。慢性盆腔炎是妇科常见病和多发病,也是导致     

75岁以上者的结直肠癌

在西方癌症是老年人第二位常见死因,而结肠直肠癌在男性中仅次于肺癌,在女性中仅次于乳癌,为老年人癌症死因的第二位。本文回顾性研究1978～1984年间Rome大学外科手术治疗的571例结直肠癌患者,其中111例75岁以上者为老年组、460例74岁以下者为对照组。比较两组年龄、性别、恶性肿瘤家族史、症状期、病损部位、淋巴结受累情况、可切除率、根治性切除的百分比、手术治疗和术后并发症。肿瘤按AstlerColler分类法分期,肿瘤组织学分为分化良好和中等的腺癌、未分化腺癌、粘液癌及鳞癌。资料采用x~2检验进行统计学分析。研究结果,在111例(19.4％)75岁以上(75～     

发热待查75例临床分析

目的探讨不明原因发热(FUO)的病因和临床特征。方法回顾性分析2005年1月～2012年1月在我科住院且符合FUO诊断标准的75例患者的临床资料,总结了病因、诊断方法和临床表现。结果 75例患者中,68例(90.7%)最终确诊,感染性疾病22例(32.4%),其中结核病9例(40.9%)、传染性单核细胞增多症5例(22.7%);结缔组织病29例(42.6%),其中成人Still病17例(58.6%)、系统性红斑狼疮6例(20.7%);恶性肿瘤10例(14.7%),其中淋巴瘤6例(60.0%);其他疾病7例(10.3%),其中组织细胞坏死性淋巴结炎4例(57.1%)。结论 FUO涉及的病因众多,发病机制复杂,感染性疾病、结缔组织病仍是发热待查的主要原因,肿瘤性疾病在发热待查中也占相当的比例,临床工作中要开阔思路,全面搜集资料,以利于明确诊断。     

75例宫颈尖锐湿疣的治疗

尖锐湿疣(CA)是常见的性病之一,由人类乳头瘤病毒(HPV)感染所致,易复发,其治疗方法有很多,应根据发病部位、疣体大小和数目选择合适的治疗方法。从2008年1月至2009年12月,长安医院门诊收治75例宫颈CA,分别采用微波及液氮冷冻治疗,取得满意     

Patients ≥75 years with acute coronary syndrome but without critical epicardial coronary disease: prevalence, characteristics, and outcome

Objective Absence of significant epicardial coronary artery disease (CAD) in patients with acute onset of chest pain and elevation of myocardial necrosis markers is occasionally observed. The aim of this study was to analyse the clinical characteristics and outcome of such patients with advanced age. Methods We retrospectively analysed 4,311 patients with acute onset of chest pain plus necrosis marker elevation. Two hundred and seventy two patients without CAD on angiogram (6.3%) were identified. Out of them, 50 (1.2%) patients ≥ 75 years (Group I) were compared with (1) 222 acute coronary syndrome (ACS) patients without CAD on angiogram < 75 years (Group II), and (2) 610 consecutive patients ≥ 75 years with Non-ST-elevation Myocardial Infarction (NSTEMI) undergoing percutaneous coronary intervention (Group III). Results Group I compared to Group III patients made up for more females (64.0% vs. 49.2%; P < 0.0001), and had more severe anginal symptoms on presentation [Canadian Cardiovascular Society (CCS) class I/II, 26.0% vs. 49.8%; P = 0.02]. Group I patients also had lower troponin levels (0.62 ± 0.8 ng/mL vs. 27 ± 74 ng/mL; P < 0.02), lower leukocyte count (9.4 ± 3.13 × 10⁹ vs. 12 ± 5.1 × 10⁹; P = 0.001) and better preserved left ventricular function (56.7% ± 14.3% vs. 45% ± 11%; P < 0.0001). Event-free survival (cardiac death, myocardial infarction, recurrent angina, and re-hospitalisation) was more frequent in Group I and II patients compared to Group III patients (64.9%, 66.7%, and 41.6%, respectively; P < 0.0001). Conclusions ACS in patients ≥ 75 years without CAD is very infrequent, associated with a (1) similar outcome compared to ACS patients < 75 years without CAD, and (2) significant better outcome compared to NSTEMI patients ≥ 75 years.     

75例疑难腹水病因分析

目的分析疑难腹水的鉴别要点,为临床上"腹水待查"的鉴别诊断提供参考。方法回顾分析2004年3月-2014年3月复旦大学附属华山医院消化科收治的排除心肝肾因素的75例疑难腹水患者的病例资料,对其病因进行分析。结果恶性肿瘤38例(50.7%);结核性腹膜炎20例(26.7%);其他罕见病因包括:肺吸虫病、POEMS综合征、胰腺囊腺瘤、嗜酸性粒细胞性胃肠炎、营养不良、布加综合征、门静脉栓塞、甲状腺功能减退症、干燥综合征等。结论排除心肝肾因素的疑难腹水中最常见的为癌性腹水,其次为结核性腹膜炎及其他罕见病。