首剂抗生素给药时间对成人社区获得性肺炎早期临床疗效影响分析

目的分析成人社区获得性肺炎(community-acquired pneumonia,CAP)早期临床稳定性的影响以及影响CAP早期临床稳定性的高危因素。方法回顾性分析成都市某三甲医院呼吸内科2012年12月至2014年12月的230例成人社区获得性肺炎病例资料,比较两组患者一般情况、临床特征、辅助检查分析不同首剂抗生素不同给药时间窗(time to first antibiotic dose,TFAD)对CAP早期临床稳定性的影响。结果参照PSI评分分析,TFAD、PSI是影响CAP早期临床疗效高危因素;参照CURB-65评分分析,TFAD、CURB-65是影响CAP早期临床疗效高危因素;参照非综合因素分析,TFAD、合并肝脏疾病是影响CAP早期临床疗效高危因素。结论 TFAD是影响CAP患者早期临床稳定性的独立危险因素,CURB-65评分≥3分、PSI评分130分、合并肝脏疾病均是影响患者早期临床疗效的危险因素。     

APACHEⅡ、qSOFA、CURB-65评分对老年社区获得性肺炎患者短期预后的预测作用研究

目的探讨急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)、快速序贯器官衰竭(qSOFA)及CURB-65评分在老年社区获得性肺炎(community-acquired pneumonia, CAP)患者短期预后中的预测价值。方法回顾分析2017年1月—2019年10月我院呼吸内科诊治的196例老年CAP患者的临床资料,依据住院28 d生存状况分为存活组126例和死亡组70例。比较两组入院时APACHEⅡ、qSOFA、CURB-65评分,不同危险程度入院APACHEⅡ、qSOFA评分、CURB-65评分患者院内病死率,采用多因素Logistic回归分析探讨APACHEⅡ、qSOFA、CURB-65评分与老年CAP患者院内死亡的关系,并应用受试者工作特征(receiver operating characteristic, ROC)曲线分析APACHEⅡ、qSOFA、CURB-65评分预测老年CAP患者短期预后的价值。结果死亡组入院时APACHEⅡ、qSOFA、CURB-65评分均高于存活组(P0.01),且APACHEⅡ、qSOFA、CURB-65评分低危、中危、高危患者院内病死率逐渐升高(P0.05);多因素Logistic回归分析显示,入院时APACHEⅡ评分≥19.0分、qSOFA评分≥2.0分、CURB-65评分≥3.0分是老年CAP患者院内死亡的独立危险因素(P0.01);APACHEⅡ、CURB-65评分预测老年CAP患者院内死亡的曲线下面积(AUC)高于qSOFA评分(Z=3.578,P=0.012;Z=4.260,P=0.005),而APACHEⅡ评分与CURB-65评分预测的AUC比较差异无统计学意义(Z=0.638,P=0.556)。结论 APACHEⅡ评分与CURB-65评分预测老年CAP患者短期预后的价值均高于qSOFA评分,但CURB-65评分涉及指标相对较少,操作简单,且预测敏感性较高,可用于老年CAP患者预后的快速评估。     

谵妄与老年社区获得性肺炎患者住院期间死亡的相关分析

目的分析老年社区获得性肺炎患者谵妄的发生率及谵妄与老年社区获得性肺炎（CAP）患者住院期间死亡的关系。方法收集在本院接受治疗的老年CAP患者126例,分成死亡组（16例）和生存组（110例）。记录所有患者年龄、性别、体质量指数、并存疾病、谵妄发生、CURB-65评分、肺炎严重指数（PSI）评分、急性病生理学和长期健康评价（APACHE）Ⅱ评分等资料,采用单因素和多因素分析谵妄与住院期间死亡的关系,采用受试者工作特征曲线分析谵妄对住院期间死亡的预测价值。结果本组老年CAP患者发生谵妄29例（23.0%）,谵妄患者住院期间病死率为31.0%（9/29）,谵妄使老年CAP患者住院期间病死率增加5.785倍。单因素分析显示,与生存组相比,住院期间死亡组患者年龄更大、谵妄发生率更高、CURB-65评分、PSI评分及APACHEⅡ评分均显著升高（t=2.081,χ2=11.425,t=5.074、4.706、4.431,P均〈0.05）。多因素Logistic回归分析显示,谵妄、CURB-65评分、PSI评分及APACHEⅡ评分是老年CAP患者住院期间死亡的独立危险因素（P均〈0.05）。受试者工作特征曲线分析显示,谵妄预测住院期间死亡有中等曲线下面积及灵敏度和特异度,且与CURB-65评分、PSI评分及APACHEⅡ评分的曲线下面积比较,差异均无统计学意义（P均〉0.05）。结论老年CAP患者谵妄发生率较高,谵妄是老年CAP患者住院期间死亡的独立危险因素,加强对谵妄的诊治可能降低CAP患者的病死率。     

急诊脓毒症病死率评分对急诊社区获得性肺炎患者预后价值的研究

急诊是社区获得性肺炎（ community-acquiredpneumonia, CAP）患者常选择的就诊地点,5％～35％的CAP 患者会进展为重症肺炎,病死率可高达20％～50％［1-2］。在繁忙的急诊室,准确评估患者病情,识别高危患者,及时恰当的治疗是降低病死率的关键。肺炎严重度指数（PSI）和社区获得性肺炎评分（CURB-65）是目前应用较广泛的肺炎病情评估标准。急诊脓毒症病死率评分（mortality in emergency department sepsis, MEDS）,是2003年Shapiro 等［3］前瞻性研究了2070例急诊疑似感染患者,筛选出与病死率相关的9个独立危险因素而组成的一套评分系统,后继多项研究验证了MEDS 对急诊脓毒症患者死亡风险预测的价值［4］。CAP 本质上属于脓毒症,本研究采用MEDS 评估CAP 患者,并与PSI 和CURB-65进行比较,探索适用于急诊的CAP 评估工具。     

老年社区获得性肺炎患者死亡危险因素分析

目的探讨老年社区获得性肺炎(CAP)患者的死亡危险因素,为老年CAP患者的临床诊治提供参考依据。方法选取我院2011～2012年急诊收治的老年CAP患者275例为研究对象,采用病例对照研究的方法,分析死亡患者的危险因素。结果死亡组年龄和呼吸频率均高于生存组,长期卧床、误吸、意识障碍、低血压(收缩压<90mmHg或舒张压<60mmHg)、重症肺炎、糖尿病、慢性阻塞性肺疾病(COPD)、胸腔积液和多叶病变的比例均高于生存组,尿素氮、血肌酐、空腹血糖、CURB-65评分高于生存组,氧合指数和白蛋白低于生存组。分别为年龄(80.3±7.4)岁vs(76.5±6.7)岁、长期卧床21例(25.6%)vs 16例(8.3%)、误吸17例(20.7%)vs 11例(5.7%)、意识障碍17例(20.7%)vs 14例(7.3%)、呼吸频率(28.39±6.87)次/min vs(22.66±5.06)次/min、低血压25例(30.5%)vs 5例(2.6%)、重症肺炎69例(84.1%)vs 85例(44.0%)、糖尿病30例(36.6%)vs 45例(23.3%)、COPD 14例(17.1%)vs 15例(7.8%)、胸腔积液16例(19.5%)vs 13例(6.7%)、多叶病变52例(63.4%)vs 58例(30.1%)、氧合指数296.37±58.10vs 334.71±37.23、尿素氮(10.52±3.36)mmol/L vs(9.21±3.13)mmol/L、血肌酐(90.46±23.21)μmol/L vs(77.74±19.79)μmol/L、白蛋白(31.48±6.02)g/L vs(34.28±3.92)g/L、空腹血糖(9.16±5.40)mmol/L vs(7.14±2.02)mmol/L、CURB-65(2.62±1.01)分vs(1.59±0.75)分(P<0.05或<0.01)。多因素logistic逐步回归表明,有6个因素(年龄、呼吸频率、低血压、血肌酐、空腹血糖、多叶病变)对死亡的影响差异有统计学意义(P<0.05)。结论老年CAP病死率高,年龄、呼吸频率、低血压、血肌酐、空腹血糖和多叶病变为老年CAP死亡危险因素。     

降钙素原在老年社区获得性肺炎中的意义

目的研究降钙素原（PCT）对老年社区获得性肺炎（CAP）病情严重程度的评估价值。方法以317例老年CAP设为重症肺炎组（111例）及普通肺炎组（206例）,并以67例健康体检老人为对照,观察PCT的检测情况,并研究PCT与PSI、CURB-65评分的相关性。结果 PCT在重症肺炎组、普通肺炎组及正常对照组依次降低,差异有统计学意义（P〈0.05）;不同PCT分级患者PSI、CURB-65评分也均有统计学差异（P〈0.05）;PCT与PSI呈正相关（r=0.689,P〈0.05）,PCT与CURB-65评分也呈正相关（r=0.511,P〈0.05）,相关系数PSI较高。结论 PCT能较好的反映CAP患者病情严重程度,对CAP患者PCT进行监测对临床治疗方案的选择、预后的评估均有重要的临床应用价值。     

中性粒细胞/淋巴细胞比值与CURB-65评分在老年社区获得性肺炎预后评价中的作用

目的:探讨中性粒细胞/淋巴细胞比值（neutrophil to lymphocyte ratio,NLR）与英国胸科协会改良肺炎评分（CURB-65评分）在老年社区获得性肺炎（community acquired pneumonia,CAP）预后评价中的作用。方法:回顾性分析2019年1月至2020年3月安徽医科大学第三附属医院呼吸与危重症医学科收治的160例老年社区获得性肺炎患者的临床资料,根据患者30 d生存情况分为存活组127例和死亡组33例。收集患者的一般临床资料和入院时或入院24 h内血常规、肝肾功能、血钠、凝血功能,C反应蛋白、降钙素原,计算NLR及CURB-65评分。通过成组 t检验或 χ２检验比较两组上述指标的差异,采用多因素Logistic回归分析筛选老年CAP患者30 d死亡的高危因素;绘制受试者工作特征曲线（receiver operating characteristic,ROC）,分析NLR及CURB-65评分对死亡风险的预测价值。 结果:与存活组比较,死亡组患者年龄更大,合并存在神经系统疾病以及出现胸闷症状的比例较高（ P<0.05）。死亡组患者淋巴细胞总数、血红蛋白及血清白蛋白水平均明显低于存活组,中性粒细胞总数、血尿素氮、D二聚体、NLR、C反应蛋白、降钙素原及CURB-65评分均明显高于存活组（均 P<0.05）。多因素Logistic回归分析显示,NLR和CURB-65评分是老年CAP 30 d死亡的独立危险因素（ P<0.01）。ROC生存曲线结果显示,NLR的曲线下面积（AUC）为0.823[95% CI（0.747~0.900）],截断值为8.885,评估预后的敏感度为84.8%,特异度为74.8%。NLR联合CURB-65评分的AUC为0.872[95% CI（0.801~0.942）],截断值为0.248,评估预后的敏感度为84.8%,特异度为84.3%。两者联合均较其他单独评价指标有更好的预后评估价值。 结论:NLR和CURB-65评分是老年CAP患者死亡的高危因素,两者联合可较好的预测老年CAP的死亡风险。     

重症肺炎患者血清磷水平与30d病死率的相关性研究

目的探讨重症肺炎患者血清磷水平与30d病死率的相关性。方法将2014年1月至2015年10月于该院呼吸科住院治疗的80例重症肺炎患者纳入本研究,根据30d死亡事件,分为死亡组(n=30)和存活组(n=50)。比较血清磷,急性生理学与慢性健康状况评价系统(APACHEⅡ)评分,肺部感染(CPIS)评分,英国胸科协会改良肺炎评分(CURB-65评分),感染相关器官衰竭评估(SOFA)评分以及肺炎严重指数(PSI)评分水平差异。结果死亡组患者血清磷水平低于存活组患者(P0.05)。ROC曲线分析提示血清磷、APACHEⅡ评分和CURB-65评分的预测30d死亡事件的AUC分别为0.732、0.664和0.682。相关性分析提示血清磷水平与30d死亡事件呈负相关(r=-0.566,P0.05)、CURB-65评分(r=-0.392,P0.05)和PSI评分(r=-0.235,P0.05)呈负相关。Logistics回归分析提示血清磷小于0.030 mmol/L(OR=1.56)和CURB-65评分大于3.9(OR=1.15)为MACE发生的独立危险因素。结论重症肺炎患者入院时血清磷水平与30d病死率密切相关。     

急诊老年社区获得性肺炎患者预后相关危险因素分析

目的:探讨急诊科老年社区获得性肺炎患者的临床特点,分析患者预后相关危险因素。方法:收集并回顾性分析3家三甲医院2018-09—2019-05期间入住急诊科的185例社区获得性肺炎患者的临床资料,将其分为预后良好组(138例)和预后不良组(47例),比较2组患者的一般资料、临床特点、CURB-65评分、PSI评分、实验室检查结果、治疗策略等,采用SPSS 20.0统计软件分析,采用单因素分析、多因素Logistic回归分析影响患者预后的危险因素,以P0.05为差异有统计学意义。结果:单因素分析结果显示,预后不良组CURB-65分数≥3分、PSI分数≥130分、外周血WBC异常比例高于预后良好组,预后良好组初始经验性抗感染治疗联合使用抗感染药物比例多于预后不良组,预后良好组PSI平均值低于预后不良组,均差异有统计学意义(P0.05);结合既往文献结果,将基础疾病多、降钙素原、乳酸也列入多因素Logistic回归分析,结果显示WBC异常、PSI评分≥130分、降钙素原水平是影响患者预后的独立危险因素(P0.05)。结论:老年社区获得性肺炎患者WBC异常、PSI评分高、降钙素原水平高等问题是预后不良的独立危险因素,应给予高度关注,以改善患者的预后。     

红细胞分布宽度对社区获得性肺炎病情严重程度及预后的评估价值

目的通过分析社区获得性肺炎(CAP)患者的红细胞分布宽度(RDW)与其严重程度及其相关影响因素的相关性,探讨RDW对社区获得性肺炎患者病情评估的应用价值。方法回顾性分析92例CAP患者临床资料,分析比较RDW与各临床特征、实验室检查指标高危因素及转归情况之间的相关关系,并应用线性回归分析相关危险因素。结果 RDW异常组中的重症患者比例、病死率等显著高于正常组;RDW异常率随着CURB-65评分的升高而增高;RDW值随着CURB-65评分的升高而升高,两者呈显著正相关(r=0.3049,P=0.0031)。结论 CAP患者的RDW水平与其严重程度及预后密切相关,RDW对其预后有重要的参考价值。     

多个评估系统对社区获得性肺炎严重度评估的荟萃分析

目的: 通过分析已有的临床数据,观察多个评估系统对社区获得性肺炎（community acquired pneumonia,CAP）患者30 d的死亡风险和ICU入住风险的预测价值。方法: 用关键词途径对2004年至2015年的PubMed和EMBASE数据库进行文献检索,并对符合条件的所有研究进行荟萃分析。结果: 共纳入文献48篇,共51 639例CAP患者采用各评价系统对其30 d死亡风险进行评估,共评估了10 590例CAP患者入住ICU的风险。通过汇总计算得出,对于30 d死亡风险的预测,CRB-65（confusion,respiratory,age 65 years）评分系统的灵敏度为98%,特异度为33%,综合受试者工作特征（summary receiver operating characteristic,sROC）曲线下面积为0.56;英国胸科协会改良肺炎评分(confusion, uremia, respiratory,blood pressure, age 65 years, CURB-65评分)系统的灵敏度为84%,特异度为55%,sROC曲线下面积为0.78;肺炎严重度指数(pneumonia severity index, PSI)系统的灵敏度为90%,特异度为57%,sROC曲线下面积为0.88;以符合2007美国感染病学会(Infectious Diseases Society of America,IDSA) /美国胸科学会（American Thoracic Society, ATS) 3项以上次要标准且不符合主要标准的评估灵敏度为76%,特异度为90%,sROC曲线下面积为0.89;采用SMART-COP评估的灵敏度为77%,特异度为65%,sROC曲线下面积为0.67。对于入住ICU风险,采用CURB-65系统评估的灵敏度为52%,特异度为77%,sROC曲线下面积为0.67;采用PSI系统评估的灵敏度为70%,特异度为61%,sROC曲线下面积为0.69;采用SMART-COP评分评估的 灵敏度为84%,特异度为70%,sROC曲线下面积为0.74。结论: PSI、CURB-65评分系统对患者30 d死亡风险的预测价值较大,可作为住院标准的重要参考。对于收住ICU的风险评估,SMART-COP的预测价值相对较大,而PSI、CURB-65评分价值相对较低。     

Red cell distribution width as a prognostic marker in patients with community-acquired pneumonia

Background

Red cell distribution width (RDW) is associated with mortality in both the general population and in patients with certain diseases. However, the relationship between RDW and mortality in patients with community-acquired pneumonia (CAP) is unknown. The objective of this study was to evaluate the association of RDW with mortality in patients with CAP.

Methods

We performed a retrospective analysis of a prospective registry database of patients with CAP. Red cell distribution width was organized into quartiles. The pneumonia severity index (PSI) and CURB-65 were calculated. The primary outcome was 30-day mortality. Secondary outcomes included the length of hospital stay, admission to the intensive care unit, vasopressor use, and the need for mechanical ventilation.

Results

A total of 744 patients were included. The PSI and CURB-65 were higher in patients with a high RDW. Multivariate logistic regression analysis identified higher categories of RDW, PSI, CURB-65, and albumin as statistically significant variables. Thirty-day mortality was significantly higher in patients with a higher RDW. Among the secondary outcomes, the length of hospital stay and vasopressor use were significantly different between the groups. In a Cox proportional hazard regression analysis, patients with higher categories of RDW exhibited increased mortality before and after adjustment of the severity scales. Receiver operating characteristics curves demonstrated improved mortality prediction when RDW was added to the PSI or CURB-65.

Conclusion

Red cell distribution width was associated with 30-day mortality, length of hospital stay, and use of vasopressors in hospitalized patients with CAP. The inclusion of RDW improved the prognostic performance of the PSI and CURB-65.     

The alveolar-arterial gradient,pneumonia severity scores and inflammatory markers to predict 30-day mortality in pneumonia

ObjectiveThe objective of this study was to evaluate the association of elevated alveolar-arterial oxygen (A-a O₂) gradient with risk of mortality in hospitalized patients with community-acquired pneumonia (CAP).MethodsThis prospective study included 206 patients diagnosed with CAP admitted to the ED. Demographics, comorbidities, arterial blood gas, serum electrolytes, liver-renal functions, complete blood count, NLR, PLR, CRP, CAR, procalcitonin, A-a O₂ gradient, expected A-a O₂ and A-a O₂ difference were evaluated. PSI and CURB-65 scores were classified as follow: a) PSI low risk (I-III) and moderate-high risk (IV-V) groups; b) CURB-65; low risk (0–2) and high risk (3–5) groups.ResultsThe survival rates of the PSI class (I-III) were significantly higher than the ones of the PSI class (IV-V) (92.1% vs. 62.9%, respectively). The percentage of survivors of the CURB-65 score (0–2) group (81.9%) was higher than the survivors of CURB-65 score (3–5) group (27.8%). Creatinine, BUN, uric acid, phosphorus, RDW, CRP, CAR, procalcitonin, lactate, A-a 0₂ gradient, expected A-a 0₂ and A-a 0₂ difference were significantly higher and basophil was lower in non-survivors. A-a O₂ gradient (AUC 0.78), A-a O₂ difference (AUC 0.74) and albumin (AUC 0.80) showed highest 30-day mortality prediction. NLR (AUC 0.58) and PLR (AUC 0.55) showed lowest 30-day mortality estimation. Procalcitonin (AUC 0.65), PSI class (AUC 0.81) and PSI score (AUC 0.86) indicated statistically significant higher 30-day mortality prediction.ConclusionA-a O₂ gradient, A-a O₂ difference and albumin are potent predictors of 30-day mortality in CAP patients in the ED.     

Evaluation of pneumonia severity scoring systems in nursing and healthcare-associated pneumonia for predicting prognosis: A prospective,cohort study

The usefulness of existing pneumonia severity indices for predicting mortality in nursing and healthcare-associated pneumonia (NHCAP) is unclear. This study compared the usefulness of existing pneumonia severity indices for predicting mortality in NHCAP and community-acquired pneumonia (CAP). Consecutive hospitalized pneumonia patients including NHCAP and CAP patients were prospectively enrolled between October 2010 and November 2017. Admission pneumonia severity was assessed using CURB-65, Pneumonia Severity Index (PSI), A-DROP, Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) severe pneumonia criteria, and I-ROAD. The primary outcome was 30-day mortality. The discriminatory ability of each severity index was evaluated by receiver operating characteristic curve analysis. Overall, 828 patients had NHCAP, and 1330 patients had CAP. Thirty-day mortality was 12.8% and 5.6% in NHCAP and CAP patients, respectively. The area under the curve of PSI (0.717, 95% confidence interval 0.673–0.761) was the highest among all pneumonia severity indices, with significant differences compared with CURB-65 (0.651, 95% confidence interval 0.598–0.705, P = 0.02) and IDSA/ATS severe pneumonia criteria (0.659, 95% confidence interval 0.612–0.707, P = 0.03). The predictive abilities for 30-day mortality of the pneumonia severity indices, excluding PSI and I-ROAD, were significantly inferior for NHCAP than for CAP. PSI may be the most useful pneumonia severity score for predicting mortality in NHCAP. However, the predictive ability for mortality of each pneumonia severity score was worse for NHCAP than for CAP; therefore, the prognostic factors in NHCAP need to be identified for better management of NHCAP patients.     

Prognostic factors in patients hospitalized with community-acquired aspiration pneumonia

IntroductionPatients with aspiration pneumonia (AP) exhibit higher mortality than those with non-AP. However, data regarding predictors of short-term prognosis in patients with community-acquired AP are limited.MethodsPatients hospitalized with community-acquired pneumonia (CAP) were retrospectively classified into aspiration pneumonia (AP) and non-AP groups. The AP patients were further divided into nonsurvivors and survivors by 30-day mortality, and various clinical variables were compared between the groups.ResultsOf 1249 CAP patients, 254 (20.3%) were classified into the AP group, of whom 76 patients (29.9%) died within 30 days. CURB-65, pneumonia severity index (PSI), and Infectious Diseases Society of America/American Thoracic Society criteria for severe CAP (SCAP) showed only modest prognostic performance for the prediction of 30-day mortality (c-statistics, 0.635, 0.647, and 0.681, respectively). Along with the PSI and SCAP, Eastern Cooperative Oncology Group performance status (ECOG-PS) and blood biomarkers, including, N-terminal of prohormone brain natriuretic peptide (NT-proBNP) and albumin, were independent predictors of 30-day mortality. In models based on clinical prediction rules, including CURB-65, PSI, and SCAP, the addition of ECOG-PS further improved their c-statistics compared to the clinical prediction rules alone. In the four combinations based on SCAP, ECOG-PS, and two blood biomarkers (NT-proBNP and albumin), the c-statistics further increased to reach approximately 0.8.ConclusionsCURB-65, PSI, and SCAP exhibited only modest discriminatory power in predicting the 30-day mortality of patients with community-acquired AP. The addition of performance status and blood biomarkers, including NT-proBNP and albumin, further increased prognostic performance, showing good predictive accuracy in the SCAP-based model.     

Prediction of severe community-acquired pneumonia: a systematic review and meta-analysis

ABSTRACT: INTRODUCTION: Severity assessment and site-of-care decisions for patients with community-acquired pneumonia (CAP) are pivotal for patients' safety and adequate allocation of resources. Late admission to the intensive care unit (ICU) has been associated with increased mortality in CAP. We aimed to review and meta-analyze systematically the performance of clinical prediction rules to identify CAP patients requiring ICU admission or intensive treatment. METHODS: We systematically searched Medline, Embase, and the Cochrane Controlled Trials registry for clinical trials evaluating the performance of prognostic rules to predict the need for ICU admission, intensive treatment, or the occurrence of early mortality in patients with CAP. RESULTS: Sufficient data were available to perform a meta-analysis on eight scores: PSI, CURB-65, CRB-65, CURB, ATS 2001, ATS/IDSA 2007, SCAP score, and SMART-COP. The estimated AUC of PSI and CURB-65 scores to predict ICU admission was 0.69. Among scores proposed for prediction of ICU admission, ATS-2001 and ATS/IDSA 2007 scores had better operative characteristics, with a sensitivity of 70% (CI, 61 to 77) and 84% (48 to 97) and a specificity of 90% (CI, 82 to 95) and 78% (46 to 93), but their clinical utility is limited by the use of major criteria.ATS/IDSA 2007 minor criteria have good specificity (91% CI, 84 to 95) and moderate sensitivity (57% CI, 46 to 68). SMART-COP and SCAP score have good sensitivity (79% CI, 69 to 97, and 94% CI, 88 to 97) and moderate specificity (64% CI, 30 to 66, and 46% CI, 27 to 66). Major differences in populations, prognostic factor measurement, and outcome definition limit comparison. Our analysis also highlights a high degree of heterogeneity among the studies. CONCLUSIONS: New severity scores for predicting the need for ICU or intensive treatment in patients with CAP, such as ATS/IDSA 2007 minor criteria, SCAP score, and SMART-COP, have better discriminative performances compared with PSI and CURB-65. High negative predictive value is the most consistent finding among the different prediction rules. These rules should be considered an aid to clinical judgment to guide ICU admission in CAP patients.     

美罗培南治疗老年社区获得性肺炎的临床疗效及血浆D-二聚体水平变化

目的 观察美罗培南治疗老年社区获得性肺炎(CAP)的临床疗效及治疗前后血浆D-二聚体水平的变化.方法 108例老年CAP患者,按病情严重程度评分标准(肺炎严重度指数-PSI)分组,均给予静脉滴注美罗培南治疗,500mg,3次/d,用药1周.评价临床效果并检测治疗前后血浆D-二聚体水平比较.结果 肺炎不同严重度指数(PSI)分级间D-二聚体水平比较,PSI V级D-二聚体显著高于Ⅱ、III、Ⅳ级,差异有统计学意义(P<0.05);III、Ⅳ、V级肺部感染控制后血浆D-二聚体水平明显下降,与治疗前比较差异有统计学意义(P<0.05).108例患者痊愈率54.6%,有效率83.3%.结论 美罗培南可作为治疗老年社区获得性肺炎的首选药物之一,血浆D-二聚体水平的监测对肺部感染的临床治疗有指导意义.