CCERW:一种预测中老年人社区获得性肺炎临床无效结局的工具
CCERW:일충예측중노년인사구획득성폐염림상무효결국적공구
CCERW: a new rule to predict treatment failure in patients with community-acquired pneumonia in middle aged and elderly people
  • 万方数据
    中国危重病急救医学 중국위중병급구의학
    CHINESE CRITICAL CARE MEDICINE
    2011年 1期 10-17 ,共8页

    李建生%侯政昆%李素云%余学庆%孙子凯%张伟%贾新华%郑四平%王明航%王海峰

    리건생%후정곤%리소운%여학경%손자개%장위%가신화%정사평%왕명항%왕해봉

    社区获得性肺炎%中老年人%预后%无效%危险因素%工具%模型 社區穫得性肺炎%中老年人%預後%無效%危險因素%工具%模型
    사구획득성폐염%중노년인%예후%무효%위험인소%공구%모형
    Community-acquired pneumonia%Middle aged%Elderly%Prognosis%Prognostic%Risk factor%Rule%Model
    目的 建立一种预测中国中老年人社区获得性肺炎(CAP)临床无效结局的工具,并与其他工具进行对比.方法 前瞻性收集2006年12月17日至2008年12月22日3所高校教学医院呼吸内科住院部收治的年龄≥45岁并确诊为CAP患者的数据,按随机数字表法将其中75%的患者数据用于工具的建立(推导组),25%的患者数据用于工具内部真实性的检验(内部组).同期收集另外一所高校教学医院的患者数据用于工具外部真实性的检验(外部组).结局定义为患者入院14 d或未满14 d出院时的临床无效状态.观测指标包括社会人口学特征、基础疾病和既往情况、并发症、症状、体征、辅助检查结果共6个方面58个因素.采用单因素分析、多因素分析和受试者工作特征曲线(ROC曲线)分析结合的方法进行工具的建立和评价,并与肺炎严重度指数(PSI)、英国胸科协会评估标准(CURB65)及其修订版(CRB65)等预测工具对临床结局的判断能力进行比较.结果 3个中心共纳入539例CAP患者的资料用于数据分析,其中推导组400例,内部组139例;外部组159例.以推导组400例数据进行单因素分析显示,共6个方面33个变量在痊愈和临床无效两组间差异有统计学意义;并以此进行多因素分析显示,精神混乱(C)、肌酐(Cr)＜60 μmol/L、电解质紊乱(E)、呼吸衰竭(R)、白细胞计数(WBC)＞7.5×109/L 5个因素差异有统计学意义.以此5个变量建立预后工具,即CCERW,将患者分为3个危险级别:得0～1分者无效率为5.5%～9.1%,得2分者无效率为12.8%～20.0%,得3～6分者无效率为31.0%～40.5%.ROC曲线分析显示,CCERW对推导组、内部组和外部组临床无效结局的预测能力分别为0.709[95%可信区间(95%CI)0.638～0.780]、0.725(95%CI 0.613～0.838)、0.686(95%CI 0.590～0.782).CCERW对全部698例患者的临床结局判断能力为0.710(95%CI 0.659～0.761),而PSI、CURB65、CRB65的判断能力分别为0.667(95%CI 0.614～0.719)、0.648(95%CI 0.592～0.705)和0.584(95%CI 0.530～0.638).结论 CCERW可帮助临床医师快速区分出中国中老年CAP患者的临床无效结局,且其对临床结局的判断能力优于PSI、CURB65、CRB65等预测工具,谨慎推荐将其在中国大陆地区汉族中老年CAP患者中使用.
    목적 건립일충예측중국중노년인사구획득성폐염(CAP)림상무효결국적공구,병여기타공구진행대비.방법 전첨성수집2006년12월17일지2008년12월22일3소고교교학의원호흡내과주원부수치적년령≥45세병학진위CAP환자적수거,안수궤수자표법장기중75%적환자수거용우공구적건립(추도조),25%적환자수거용우공구내부진실성적검험(내부조).동기수집령외일소고교교학의원적환자수거용우공구외부진실성적검험(외부조).결국정의위환자입원14 d혹미만14 d출원시적림상무효상태.관측지표포괄사회인구학특정、기출질병화기왕정황、병발증、증상、체정、보조검사결과공6개방면58개인소.채용단인소분석、다인소분석화수시자공작특정곡선(ROC곡선)분석결합적방법진행공구적건립화평개,병여폐염엄중도지수(PSI)、영국흉과협회평고표준(CURB65)급기수정판(CRB65)등예측공구대림상결국적판단능력진행비교.결과 3개중심공납입539례CAP환자적자료용우수거분석,기중추도조400례,내부조139례;외부조159례.이추도조400례수거진행단인소분석현시,공6개방면33개변량재전유화림상무효량조간차이유통계학의의;병이차진행다인소분석현시,정신혼란(C)、기항(Cr)＜60 μmol/L、전해질문란(E)、호흡쇠갈(R)、백세포계수(WBC)＞7.5×109/L 5개인소차이유통계학의의.이차5개변량건립예후공구,즉CCERW,장환자분위3개위험급별:득0～1분자무효솔위5.5%～9.1%,득2분자무효솔위12.8%～20.0%,득3～6분자무효솔위31.0%～40.5%.ROC곡선분석현시,CCERW대추도조、내부조화외부조림상무효결국적예측능력분별위0.709[95%가신구간(95%CI)0.638～0.780]、0.725(95%CI 0.613～0.838)、0.686(95%CI 0.590～0.782).CCERW대전부698례환자적림상결국판단능력위0.710(95%CI 0.659～0.761),이PSI、CURB65、CRB65적판단능력분별위0.667(95%CI 0.614～0.719)、0.648(95%CI 0.592～0.705)화0.584(95%CI 0.530～0.638).결론 CCERW가방조림상의사쾌속구분출중국중노년CAP환자적림상무효결국,차기대림상결국적판단능력우우PSI、CURB65、CRB65등예측공구,근신추천장기재중국대륙지구한족중노년CAP환자중사용.
    Objective To develop and validate a clinical rule to predict treatment failure in middleaged and elderly patients suffering from community-acquired pneumonia (CAP) in China, and to compare it with other prognostic rules. Methods Data of 58 variables affiliated to 6 aspects, including demographics,underlaying diseases, previous status, complications, symptoms, signs and laboratory examination results from the CAP patients aged ≥ 45 years admitted to the respiratory departments in three university affiliated hospitals between December 17, 2006 and December 22, 2008 were enrolled prospectively and then validated in two groups to create a derivation cohort with 75% of the patients for rule development and an internal validation cohort with the other 25% for internal test. An external validation cohort was formed at the same time with patients admitted to the other university affiliated hospital for external test. The single outcome was treatment failure at the time of 14 days after admitted or at discharge from hospital. Univariate analysis, multivariate analysis and receiver operating characteristics (ROC) curve were used for the rule establishment, assessment and comparison among the pneumonia severity index (PSI), CURB65 [confusion,blood urea nitrogen＞6.8 mmol/L, respiratory rate (RR)≥30 breaths per minute, systolic blood pressure (SBP)＜90 mm Hg (1 mm Hg=0. 133 kPa) or diastolic blood pressure (DBP)≤60 mm Hg, age≥65 years]and CRB65 (confusion, RR ≥ 30 breaths per minute, SBP ＜ 90 mm Hg or DBP ≤ 60 mm Hg,age≥65 years). Results The data of a total of 539 patients in three hospitals were enrolled for analysis. Ofthose, 400 and 139 patients were randomly allocated into the derivation cohort or internal validation cohort respectively. Meanwhile, 159 patients were enrolled in the external validation cohort. Analyzing the data from 400 patients in the derivation cohort, 33 variables of 6 aspects had significant difference between cure and treatment failure outcome in the univariate analysis. Then, in the multivariate analyses, five independent predictive factors showed significant difference, including confusion (C), creatinine ＜60 μmol/L, electrolyte disturbances (E), respiratory failure (R), white blood cell (WBC)＞7.5× 109/L. A clinical prediction rule CCERW based on these variables showed that the treatment failure outcome increased directly with increasing scores : 5.5%- 9. 1 %, 12.8 %- 20. 0% and 31.0 %- 40. 5% for scores of 0 - 1, 2 and 3 - 6, respectively. ROC curve analysis yielded an area under the curve (AUC) for CCERW of 0. 709 [95% confidence intervals (95%CI) 0.638 - 0.780], 0.725 (95%CI 0.613 - 0.838) and 0.686 (95%CI 0.590 - 0.782) in the derivation, internal and external validation cohorts respectively; and in the same manner, of 0.710(95%CI 0. 659 - 0. 761) for total 698 patients, which was better than PSI, CURB65 and CRB65, at 0. 667(95%CI 0. 614 - 0. 719), 0. 648 (95%CI0. 592 - 0. 705), and 0. 584 (95%CI 0.530 - 0.638), respectively.Conclusion CCERW can help physicians to distinguish high and low risk leading to treatment failure in middle-aged and elder patients with CAP, and has better predictable capability than PSI, CURB65 and CRB65. We prudent recommend the simple rule can be used in the middle-aged and elder patients with CAP of Han race people in China.
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