老年社区获得性肺炎严重度指数PSI和CURB-65评分应用价值研究

目的 分析老年社区获得性肺炎严重度指数PSI和CURB-65评分应用价值;方法取本院住院的老年社区获得性肺炎患者86例作为研究对象,所有患者均符合诊断标准,根据治疗效果不同将所有患者分为有效组与无效组,比较两组患者的疾病情况、PSI及CURB-65评分、敏感性及特异性;结果有效组患者的年龄、合并多种慢性基础疾病、住院时间均明显低于无效组患者（P〈0.05）;治疗4 d后无效组PSI及CURB-65评分明显升高,有效组明显降低,两组间比较差异有显著性（P〈0.05）;PSI评分的敏感性明显高于CURB-65评分（P〈0.05）,特异性低于CURB-65评分（P〈0.05）;结论 PSI和CURB-65评分可以有效判断老年社区获得性肺炎患者的病情严重程度并指导治疗.     

普通病房与呼吸监护病房老年社区获得性肺炎住院患者的对比分析

目的比较普通病房与呼吸重症监护病房老年社区获得性肺炎患者临床特点及预后的差异,并探讨年龄≥65岁者意识、尿素氮、呼吸率和血压评分（CURB-65评分）是否可作为判断收入监护病房的标准。方法以我院2009年3月～2010年2月期间住院的老年社区获得性肺炎患者为研究对象,收集患者的临床资料,按住院地点分组,比较各项危险因素对预后的影响,并进行CURB-65评分。结果与普通病房社区获得性肺炎患者比较,监护病房男性、脑卒中、长期吸烟者均显著增加;监护病房患者更易出现酸中毒和低氧血症,尿素氮升高,红细胞压积下降,胸腔积液或多叶段肺炎。老年社区获得性肺炎患者CURB-65低危组死亡率为4％,中危组死亡率为13％,高危组死亡率为50％。结论呼吸监护病房社区获得性肺炎患者多伴脑卒中或合并症。CURB-65对判断老年社区获得性肺炎患者治疗地点有参考价值,但可能会低估老年患者的病情。     

PSI评分和CURB-65评分判断慢性阻塞性肺疾病急性加重合并肺部感染患者预后的价值

正肺炎严重度评分(pneumonia severity index,PSI)评分和社区获得性肺炎CURB-65评分是临床常用的社区获得性肺炎的预后评估系统~([1,2])CURB-65评分包括5个指标:意识障碍、尿素氮≥70 mmol/L、呼吸频率≥30次/min、收缩压90mmHg或舒张压≤60mmHg、年龄≥65岁,CURB-     

抗生素选择策略在老年社区获得性肺炎治疗中的价值

目的 评价不同抗生素选择对老年社区获得性肺炎(CAP)的疗效,以明确指南在老年CAP中的价值.方法 回顾性分析2007年1月至2011年12月间进行的CAP研究资料,将住院治疗、年龄≥65岁CAP患者,分为指南依从组及非依从组,比较临床稳定时间、住院时间、总病死率,筛选危险因素.结果 与非依从组相比,依从组有较短的临床稳定时间及住院时间,7d临床稳定率显著高于非依从组.依从组总死亡率亦低于非依从组.高CURB-65评分、多肺叶病变及非依从治疗与患者的死亡密切相关.结论 符合指南推荐的抗生素治疗,可改善老年CAP的临床稳定率,缩短住院时间,降低死亡率.     

社区获得性肺炎患者血清CC16和CRP蛋白检测及临床意义

目的检测社区获得性肺炎(CAP)患者血清CC16蛋白和C-反应蛋白(CRP)浓度,探讨CC16和CRP蛋白在社区获得性肺炎中的临床意义。方法将46例符合诊断标准的社区获得性肺炎患者作为病例组,28例健康体检者作为对照组,病例组根据PSI评分和CURB-65评分,分为低危组、中危组和高危组,分别采用酶联免疫吸附法和速率散射免疫比浊法检测CAP患者血清中CC16和CRP浓度。结果 1.社区获得性肺炎组的血清CC16浓度显著低于健康对照组,且CC16下降的程度和患者病情的严重程度显著相关。2.社区获得性肺炎组的血清CRP浓度显著高于对照组,且CRP增高的程度与患者病情的严重程度显著相关。3.患者血清中CC16和CAP的浓度呈负相关。4.PSI和CURB-65评分系统均可有效判断社区获得性肺炎患者的病情严重程度。结论 CC16和CRP和社区获得性肺炎的发生、发展密切相关,结合利用PSI和CURB-65评分系统,对病情判断和治疗具有重要的指导意义。     

血清C反应蛋白及D-二聚体水平与社区获得性肺炎的相关性分析

目的:探究血清C反应蛋白(CRP)及D-二聚体(D-D)水平与社区获得性肺炎的相关性。方法:收集124例社区获得性肺炎患者,根据肺炎严重程度指数(PSI)和社区获得性肺炎(CURB-65)评分分别进行分组,对比不同病情程度患者的血清CRP及D-D水平差异,分析CRP及D-D水平与PSI、CURB-65评分的相关性。结果:根据PSI分级患者分为重度组35例,中度组49例,低度组40例。血清CRP及D-D水平重度组中度组低度组,组间比较差异有统计学意义(均P 0. 05)。根据CURB-65评分患者分为高危组26例,中危组51例,低危组47例。血清CRP及D-D水平高危组中危组低危组,组间比较差异有统计学意义(均P 0. 05)。相关性分析结果显示,CRP与PSI分级、CURB-65评分均有显著相关(r=0. 374,0. 405,P 0. 05),D-D与PSI分级、CURB-65评分均有显著相关(r=0. 359,0. 392,P 0. 05)。结论:CRP及D-D水平与社区获得性肺炎患者的病情严重程度明显相关,可作为评估此类疾病严重程度的辅助指标。     

北京市某三甲医院老年社区获得性肺炎住院患者诊治现况调查

目的 调查北京某三甲医院老年社区获得性肺炎( CAP)住院患者的诊治现状,并与中国2016年版《成人社区获得性肺炎诊断和治疗指南》推荐的诊治方案进行对比,探讨诊治过程中存在的问题.方法 选择2020年1月至12月于首都医科大学附属北京友谊医院住院的295例老年CAP患者为研究对象.根据CAP评分量表( CURB-65)...     

临床路径在小儿社区获得性肺炎中的应用

目的探讨临床路径管理在小儿社区获得性肺炎中应用效果。方法回顾性分析我院儿科住院治疗的社区获得性肺炎患儿860例。常规治疗组438例,采用传统的医疗模式,按经验进行治疗、护理及相关检查。临床路径组422例,依据临床路径流程实施检查、治疗及护理。比较两组间住院天数,总住院费用,抗生素的费用。结果两组间比较,临床路径组住院时间[(8±1.2)d]、总住院费用[(4472.28±524.30)元]和抗生素费用[(86.43±25.80)元]均低于常规治疗组[(9.5±1.5)d、(5182.07±467.54)元和(176.68±18.62)元],差异均有统计学意义(P0.05)。结论临床路径应用于小儿社区获得性肺炎管理中,诊疗过程更加规范,缩短住院时间,住院费用、抗生素费用降低,而不影响临床疗效。     

监测血浆N末端B型钠尿肽前体联合CURB-65评分对社区获得性重症肺炎预后评估的价值

目的 探讨血浆N末端B型钠尿肽前体(NT-proBNP)联合CURB-65评分对社区获得性重症肺炎近期(28 d)预后的评估价值.方法 采用回顾性临床研究,研究对象为2010年3月至2013年3月本院ICU就诊的社区获得性重症肺炎患者74例,入院后2h内即检测NT-proBNP,并进行CURB-65评分,根据28 d预后将患者分为成活组(50例)和死亡组(24例),对两组的NT-proBNP及CURB-65评分进行比较,并将NT-proBNP与CURB-65评分联合对预后进行评估.结果 死亡组在入院当日NT-proBNP水平为(2 872.80±790.16) μg/L,CURB-65评分为(3.57±1.04)分,显著高于成活组[(1 739.53±803.55) μg/L,(2.53±0.958)分,t值分别为2.865、2.06,P＜0.01或＜0.05].监测NT-proBNP、CURB-65评分以1 761.22 μg/L、3分为截断值时诊断敏感度及特异度分别为83％、64％及79％、76％,ROC曲线下面积分别为0.75 (95％ CI:63.3％～86.9％)及0.76(95％ CI:63.9％～88.4％).2种指标联合诊断敏感度及特异度分别为87％、91％,ROC曲线下面积为0.92.结论 监测NT-proBNP与CURB-65评分同样具有较好的预测社区获得性重症肺炎患者预后的价值,特别是将两者联合进行评估,有更好的敏感性与特异性,值得临床推广.     

常见评分系统对社区获得性肺炎预后的效果评价

目的探讨CURB-65评分、A-DROP评分、q-SOFA评分和中性粒细胞/淋巴细胞比值(NLR)对社区获得性肺炎(CAP)死亡率的预测价值。方法回顾性分析2016年1月-2018年12月间安徽医科大学第二附属医院呼吸与危重医学科收治的196例CAP患者的临床资料,所有病例均符合纳入排除标准。入院后24 h内测量生命体征,并在抗生素治疗前收集患者静脉血,测定血清生化等指标,通过比较受试者工作特征曲线(ROC)分析CURB-65、A-DROP、q-SOFA和NLR对患者30 d死亡率的预测效能。结果196例患者30d死亡率为12.7%,CURB-65、A-DROP、q-SOFA和NLR预测死亡率的曲线下面积分别是0.73、0.63、0.69和0.69。结论CURB-65、A-DROP、q-SOFA和NLR均可用于CAP死亡率的预测。其中CURB-65预测效能最高,但易受到医疗条件的限制;qSOFA检测指标要求不高,利于CAP的快速分级。     

Low CURB-65 is of limited value in deciding discharge of patients with community-acquired pneumonia

Background

The relationship between clinical judgment and indications of the CURB-65 score in deciding the site-of-care for patients with community-acquired pneumonia (CAP) has not been fully investigated. The aim of this study was to evaluate reasons for hospitalization of CAP patients with CURB-65 score of 0 and 1.

Methods

An observational, retrospective study of consecutive CAP patients was performed at the Fondazione Cà Granda, Milan, Italy, between January 2005 and December 2006. The medical records of hospitalized patients with CAP having a CURB-65 score of 0 and 1 were identified and reviewed to determine whether there existed a clinical basis to justify hospitalization.

Results

Among the 580 patients included in the study, 218 were classified with a CURB-65 score of 0 or 1. Among those, 127 were hospitalized, and reasons that justified hospitalization were found in 104 (83%) patients. Main reasons for hospitalization included the presence of hypoxemia on admission (35%), failure of outpatient therapy (14%) and the presence of cardiovascular events on admission (9.7%). Used as the sole indicator for inappropriate hospitalization, the CURB-65 score had a poor positive predictive value of 52%.

Conclusions

Although the CURB-65 has been proposed as a tool to guide the site of care decision by international guidelines, this score is not ideal by itself, and should not be regarded as providing decision support information if a score of 0 and 1 is present. In CAP patients with CURB-65 scores of 0 or 1, further evaluations should be performed and completed by clinical judgment.     

Pneumonia severity index compared to CURB-65 in predicting the outcome of community acquired pneumonia among patients referred to an Iranian emergency department: a prospective survey

ObjectiveTo compare the prognostic value of the pneumonia severity index and the severity score for community-acquired pneumonia (CURB-65) in predicting mortality and the need for ICU admission of patients with community-acquired pneumonia referred to our emergency department.Materials and methodsThis prospective study was performed on patients with community-acquired pneumonia admitted to the emergency department of Imam Hossein Medical Center, Tehran, Iran. A questionnaire with demographic information, clinical signs and symptoms, laboratory and radiographic findings was completed for each patient. The information required for calculating the pneumonia severity index and CURB-65 were extracted from the medical records. The patients’ clinical outcome was also recorded within a month after admission.ResultsWe studied 200 patients with community-acquired pneumonia (122 men, 78 women). The sensitivity and specificity of CURB-65 in predicting mortality were 100% and 82.3%, respectively. As for pneumonia severity index, the rates were 100% and 75%, respectively. The sensitivity and specificity rates of CURB-65 and pneumonia severity index in predicting mortality and need for ICU admission were 96.7% and 89.3%, and 90% and 78.7%, respectively.ConclusionCURB-65 seems to be the preferred method to predict mortality and need for ICU admission in patients with community-acquired pneumonia. Despite their comparable specificity and sensitivity, CURB-65 is much easier to implement.     

Validation of a predictive rule for the management of community-acquired pneumonia.

The CURB-65 score (Confusion, Urea > 7 mmol x L(-1), Respiratory rate > or = 30 x min(-1), low Blood pressure, and age > or = 65 yrs) has been proposed as a tool for augmenting clinical judgement for stratifying patients with community-acquired pneumonia (CAP) into different management groups. The six-point CURB-65 score was retrospectively applied in a prospective, consecutive cohort of adult patients with a diagnosis of CAP seen in the emergency department of a 400-bed teaching hospital from March 1, 2000 to February 29, 2004. A total of 1,100 inpatients and 676 outpatients were included. The 30-day mortality rate in the entire cohort increased directly with increasing CURB-65 score: 0, 1.1, 7.6, 21, 41.9 and 60% for CURB-65 scores of 0, 1, 2, 3, 4, and 5, respectively. The score was also significantly associated with the need for mechanical ventilation and rate of hospital admission in the entire cohort, and with duration of hospital stay among inpatients. The CURB-65 score (Confusion, Urea > 7 mmol x L(-1), Respiratory rate > or = 30 x min(-1), low Blood pressure, and age > or = 65 yrs), and a simpler CRB-65 score that omits the blood urea measurement, helps classify patients with community-acquired pneumonia into different groups according to the mortality risk and significantly correlates with community-acquired pneumonia management key points. The new score can also be used as a severity adjustment measure.     

Swedish guidelines for the management of community-acquired pneumonia in immunocompetent adults

This document presents the evidence-based guidelines of the Swedish Society of Infectious Diseases for the management of adult immunocompetent patients with community-acquired pneumonia (CAP), who are assessed at hospital. The prognostic score 'CURB-65' is recommended for all CAP patients in the emergency room. The score provides an assessment tool for the decision regarding outpatient treatment or level of hospital supervision, the choice of microbiological investigations, and empirical antibiotic treatment. In patients with non-severe CAP (CURB-65 score 0-2) we recommend initial narrow-spectrum antibiotic treatment, orally or intravenously, primarily directed at Streptococcus pneumoniae. In those with CURB-65 score 3, penicillin G or a cephalosporin intravenously is recommended. For CURB-65 score 0-3 atypical pathogens should be covered only when they are suspected on clinical or epidemiological grounds. In patients with CURB-65 score 4-5 intravenous combination therapy with either cephalosporin/macrolide or penicillin G/fluoroquinolone is recommended. Efforts should be made to identify the CAP aetiology in order to support the ongoing antibiotic treatment or to suggest treatment alterations. Recommended measures for prevention of CAP include influenza -- and pneumococcal -- vaccination to risk groups and efforts for smoking cessation.     

Scoring systems to evaluate prognosis of community-acquired pneumonias

Several expert systems were developed for assessment of community-acquired pneumonia (CAP) and its severity in individual patients. Scoring systems PSI, CURB-65, and CRB-65 are widely used. They were primarily designed for easier decision on need of CAP patients hospitalization. Newer scoring systems evaluate especially severity of CAP and need of intensive care. This group of systems comprise ATS/IDSA recommendations, CURXO-8O, SMART-COP, and SMRT-CO. The last one appears to be the most appropriate for common practice but more studies are necessary to confirm this opinion. Regardless of the scoring systems the authors recommend more extensive usage of pulse oxymetry in the care of CAP patients.     

入院时血乳酸水平联合重症评分对社区获得性肺炎患者预后的评估价值

目的:探讨入院时血乳酸水平联合快速脓毒症相关器官衰竭评分(qSOFA)、CRB/CURB-65评分对社区获得性肺炎(CAP)患者预后的评估价值。方法:回顾性收集入院8 h内有测定乳酸的512例CAP患者,均计算每例患者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,行logistic回归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,发生不良预后的几率越高: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,联合血乳酸水平后CRB-65(0.761～0.795)、CURB-65(0.791～0.835)和qSOFA(0.770～0.837)评分的预测效能提高,qSOFA评分提高最明显。结论:单独CURB-65评分对住院CAP患者短期不良结局的预测价值优于qSOFA和CRB-65评分,但联合血乳酸水平后qSOFA评分具有更大的效力,对重症患者的检出可能更有利。     

Performance of PSI, CURB-65, and SCAP scores in predicting the outcome of patients with community-acquired and healthcare-associated pneumonia

The objective was to compare three score systems, pneumonia severity index (PSI), the Confusion-Urea-Respiratory Rate-Blood pressure-65 (CURB-65), and severe community-acquired pneumonia (SCAP), for prediction of the outcomes in a cohort of patients with community-acquired (CAP) and healthcare-associated pneumonia (HCAP). Large multi-center, prospective, observational study was conducted in 55 hospitals. HCAP patients were included in the high classes of CURB-65, PSI and SCAP scores have a mortality rate higher than that of CAP patients. HCAP patients included in the low class of the three severity rules have a significantly higher incidence of adverse events, including development of septic shock, transfer into an ICU, and death (p < 0.01). At multivariate Cox regression analysis, inclusion in the severe classes of PSI, CURB-65, or SCAP scores and receipt of an empirical therapy not adherent to international guidelines prove to be risk factors independently associated with poor outcome. PSI, CURB-65, and SCAP score have a good performance in patients with CAP but are less useful in patients with HCAP, especially in patients classified in the low-risk classes.     

Administration of first hospital antibiotics for community-acquired pneumonia: does timeliness affect outcomes?

PURPOSE OF REVIEW: Associations between processes of care for hospitalized community-acquired pneumonia patients and clinical outcomes are important because of the high incidence of such admissions and substantial related mortality. Several studies have examined these associations. RECENT FINDINGS: Large retrospective studies of older patients have demonstrated associations between time to first dose as short as 4 h and length of stay and mortality during and after hospitalization. Results of smaller studies have been less consistent. The association appears to be strongest among older patients who have not received antibiotics prior to arrival at the hospital. SUMMARY: A significant and causal relationship appears to exist between antibiotic timing and improved outcomes, especially among older patients. Even modest improvements in timeliness of antibiotic administration could impact a substantial number of lives because of the high incidence of community-acquired pneumonia hospitalization.