慢性阻塞性肺疾病急性加重合并社区获得性肺炎短期死亡及不良结局预测模型的验证研究  

Validation of predictive models for short-term mortality and adverse outcomes in acute exacerbation of chronic obstructive pulmonary disease with community-acquired pneumonia

作　　者：刘玉[1] 张嘉瑞 罗远明[2] 魏海龙[3] 葛慧青[4] 刘辉国[5] 张建初[6] 潘频华[7] 李先华[8] 周晖[9] 谢秀芳[8] 程丽娜 易梦秋 周宸 阿地拉·艾力 彭丽阁 蒲佳琪 刘亮[9] 张小红[12] 冯海沜 周海霞[1] 易群 LIU Yu;ZHANG Jiarui;LUO Yuanming;WEI Hailong;GE Huiqing;LIU Huiguo;ZHANG Jianchu;PAN Pinhua;LI Xianhua;ZHOU Hui;XIE Xiufang;CHENG Li'na;YI Mengqiu;ZHOU Chen;Adila·Aili;PENG Lige;PU Jiaqi;LIU Liang;ZHANG Xiaohong;FENG Haipan;ZHOU Haixia;YI Qun(Department of Respiratory and Critical Care Medicine,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,P.R.China;State Key Laboratory of Respiratory Diseases,Guangzhou Medical University,Guangzhou,Guangdong 510120,P.R.China;Department of Respiratory and Critical Care Medicine,Leshan People's Hospital of Sichuan Province,Leshan,Sichuan 614000,P.R.China;Department of Respiratory and Critical Care Medicine,Run Run Shaw Hospital,School of Medicine,Zhejiang University,Hangzhou,Zhejiang 310000,P.R.China;Department of Respiratory and Critical Care Medicine,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei 430030,P.R.China;Department of Respiratory and Critical Care Medicine,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei 430030,P.R.China;Department of Respiratory and Critical Care Medicine,Xiangya Hospital,Central South University,Changsha,Hunan 410000,P.R.China;Department of Respiratory and Critical Care Medicine,Neijiang First People's Hospital,Neijiang,Sichuan 641000,P.R.China;Department of Respiratory and Critical Care Medicine,Affiliated Hospital of Chengdu University,Chengdu,Sichuan 610081,P.R.China;Department of Emergency,Jiujiang First People's Hospital,Jiujiang,Jiangxi 332000,P.R.China;West China Medical College of Sichuan University,Chengdu,Sichuan 610041,P.R.China;Department of Respiratory and Critical Care Medicine,Chengdu Sixth People's Hospital,Chengdu,Sichuan 610051,P.R.China;Sichuan Cancer Hospital,Chengdu,Sichuan 610042,P.R.China)

机构地区：[1]四川大学华西医院呼吸与危重症医学科,四川成都610041 [2]广州医科大学呼吸系统疾病国家重点实验室,广东广州510120 [3]乐山市人民医院呼吸与危重症医学科,四川乐山614000 [4]浙江大学医学院附属邵逸夫医院呼吸与危重症医学科,浙江杭州310000 [5]华中科技大学同济医学院附属同济医院呼吸与危重症医学科,湖北武汉430030 [6]华中科技大学同济医学院附属协和医院呼吸与危重症医学科,湖北武汉430030 [7]中南大学湘雅医院呼吸与危重症医学科,湖南长沙410000 [8]内江市第一人民医院呼吸与危重症医学科,四川内江641000 [9]成都大学附属医院呼吸与危重症医学科,四川成都610081 [10]九江市第一人民医院急诊科,江西九江332000 [11]四川大学华西临床医学院,四川成都610041 [12]成都市第六人民医院呼吸与危重症医学科,四川成都610051 [13]四川省肿瘤医院,四川成都610042

出　　处：《中国呼吸与危重监护杂志》2023年第3期159-167,共9页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：四川省科技计划重点研发项目(2022YFS0262);国家重点研发计划(2016YFC1304202)。

摘　　要：目的比较BAP-65评分、DECAF评分、CURB-65评分和PSI评分对慢性阻塞性肺疾病(简称慢阻肺)急性加重合并社区获得性肺炎(community-acquired pneumonia,CAP)患者短期死亡及不良结局的预测价值。方法收集2017年9月—2021年7月国内10家大型三甲医院因慢阻肺急性加重合并CAP住院的患者,调查30天内全因死亡率。根据患者是否死亡,分为死亡组和生存组,比较两组患者的基本情况、合并症、症状及体征、辅助检查结果等,并探讨30天内全因死亡的独立危险因素。使用4种量表对纳入患者进行评分及分级,基于受试者操作特征曲线比较4种量表预测短期死亡及不良结局的有效性。结果本研究共纳入3375例,其中男2545例,女830例,平均年龄(73.66±10.73)岁。30天内,129例(3.82%)患者发生死亡,614例(18.19%)患者发生不良结局(包括全因死亡、有创机械通气和入住重症加强治疗病房)。研究发现意识状态改变、糖尿病、心房颤动、慢性肺源性心脏病、年龄、脉率、血清白蛋白、舒张压、pH值是慢阻肺急性加重合并CAP患者30天内死亡的独立危险因素。CURB-65评分、BAP-65评分、DECAF评分、PSI评分预测全因死亡的受试者操作特征曲线下面积分别是0.780、0.782、0.614、0.816,预测不良结局的曲线下面积分别是0.694、0.687、0.564、0.705。PSI评分对全因死亡及不良结局预测效能均最佳,DECAF评分最差。结论慢阻肺急性加重合并CAP患者30天内全因死亡率及不良结局发生率较高,意识状态改变、糖尿病、心房颤动、慢性肺源性心脏病、年龄、脉率、血清白蛋白、舒张压、pH值是慢阻肺急性加重合并CAP患者30天内死亡的独立危险因素。PSI评分对慢阻肺急性加重合并CAP患者的30天内全因死亡及不良结局预测效能最佳,DECAF评分最差。Objective To compare the predictive value of the BAP-65 score,the DECAF score,the CURB-65 score,and the Pneumonia Severity Index(PSI)on short-term mortality and adverse outcomes in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)with community-acquired pneumonia(CAP).Methods This study enrolled patients hospitalized for AECOPD and CAP from ten hospitals in China from September 2017 to July 2021.All-cause mortality within 30 days was investigated.Patients were divided into the death and the survival groups according to their survival status.The differences in basic conditions,complications,symptoms,signs and auxiliary examination results between the two groups were compared,and the independent risk factors of all-cause mortality were analyzed.The included patients were scored and graded according to the 4 scales,respectively,and the validity of the four scales in predicting short-term mortality and adverse outcomes was compared based on the receiver operating charateristic(ROC)curve analysis.Results A total of 3375 patients including 2545 males and 830 females with a mean age of(73.66±10.73)years were enrolled in this study.Within 30 days,129(3.82%)patients died and 614(18.19%)patients had an adverse outcome(including all-cause death,invasive mechanical ventilation and admission into intensive care unit).Altered state of consciousness,diabetes mellitus,atrial fibrillation,chronic pulmonary heart disease,age,pulse rate,serum albumin,diastolic blood pressure,and pH value were independent risk factors for 30-day mortality in AECOPD patients with CAP.The area under the ROC curve(AUC)of the CURB-65 score,BAP-65 score,DECAF score,and PSI score for predicting all-cause mortality were 0.780,0.782,0.614,and 0.816,and these AUCs for predicting adverse outcomes were 0.694,0.687,0.564 and 0.705,respectively.PSI score had the best predictive efficacy for all-cause mortality and adverse outcomes,and the DECAF score had the worst predictive efficacy.Conclusions AECOPD patients with CAP have a re

关 键 词：慢性阻塞性肺疾病急性加重 社区获得性肺炎 BAP-65评分 DECAF评分 CURB-65评分 PSI评分 

分 类 号：R563.9[医药卫生—呼吸系统] R563.1[医药卫生—内科学]