快速Pitt菌血症评分联合乳酸预测急性下呼吸道感染患者的死亡风险  

Quick Pitt bacteremia score combined with lactate predicts the mortality risk in the patients with acute lower respiratory tract infection

作　　者：刘温馨 张野 梁梦琳 腾飞[1] 梅雪[1] Liu Wenxin;Zhang Ye;Liang Menglin;Teng Fei;Mei Xue(Emergency Medicine Center,Beijing Chaoyang Hospital,Capital Medical University&Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院急诊医学中心心肺脑复苏北京市重点实验室,北京100020

出　　处：《中国急救医学》2024年第6期537-541,共5页Chinese Journal of Critical Care Medicine

基　　金：北京市医院管理局临床医学发展专项——“扬帆计划”(ZYLX202132);北京市医院管理中心“培育”计划(PX2023012)。

摘　　要：目的分析快速皮特菌血症(qPitt)评分联合急诊常用指标是否可作为急性下呼吸道感染患者28 d死亡风险的预测因素。方法以2018年7月1日至2023年12月31日收治于首都医科大学附属北京朝阳医院急诊科的急性下呼吸道感染患者为研究对象,以入院后28 d死亡为终点,将研究对象分为存活组和死亡组。使用单因素分析比较两组qPitt评分和临床指标的差异,并通过Logistic回归筛选影响急性下呼吸道感染患者28 d死亡的独立相关因素,建立联合预测模型,使用受试者工作特征(ROC)曲线评价独立相关因素及联合变量预测模型对急性下呼吸道感染患者28 d死亡的预测价值。结果共纳入患者696例,其中28 d存活组445例(63.9%)和28 d死亡组251例(36.1%)。死亡组年龄、降钙素原、D-二聚体、血乳酸(lactate,LAC)、血肌酐(SCr)及qPitt评分均高于存活组(均P<0.05),淋巴细胞计数和血小板计数均低于存活组(均P<0.05)。Logistic回归分析得出LAC(OR=1.258,95%CI 1.143~1.384,P<0.001)、年龄(OR=1.021,95%CI 1.008~1.034,P=0.001)及qPitt评分(OR=1.923,95%CI 1.597~2.317,P<0.001)是预测急性下呼吸道感染患者28 d死亡风险的独立因素。年龄、LAC与qPitt评分联合变量预测模型的ROC曲线下面积(area under curve,AUC)为0.746(95%CI 0.708~0.784),高于LAC(AUC=0.692,95%CI 0.650~0.733)和qPitt评分(AUC=0.702,95%CI 0.660~0.743),且其预测效能优于单独应用LAC(Z=2.888,P=0.004)和qPitt评分(Z=3.850,P<0.001)。结论qPitt评分和LAC是急性下呼吸道感染患者死亡的独立危险因素,二者与年龄构建的联合变量预测模型可有效预测28 d死亡风险。Objective To investigate whether Pitt quick bacteremia(qPitt)score combined with common laboratory indicators in emergency department could be used as the predictors of 28-day mortality risk in acute lower respiratory tract infection patients.Methods A retrospective study was conducted on the patients with acute lower respiratory tract infection who were admitted to the Emergency Department of Beijing Chaoyang Hospital,Capital Medical University from July 1,2018 to December 31,2023.The patients were divided into survival group and death group according to the 28-day prognosis after admission.The differences of clinical indicators and qPitt score between the two groups were analyzed through univariate analysis.Logistic regression was used to screen the independent factors associated with 28-day mortality in acute lower respiratory tract infection patients,and a combined prediction model was established.The predictive value of independent correlation factors and combined variable model for 28-day mortality in acute lower respiratory tract infection patients was evaluated by using receiver operating characteristic(ROC)curves.Results A total of 696 patients were enrolled in this study,including 445 cases(63.9%)in the survival group and 251 cases(36.1%)in the death group.The age,procalcitonin,D-dimer,blood lactate(LAC),serum creatinine(SCr)and qPitt score in the death group were higher than those in the survival group(P<0.05),while the numbers of lymphocyte and platelet in the death group were lower than those in the survival group(P<0.05).Logistic regression analysis showed that LAC(OR=1.258,95%CI 1.143-1.384,P<0.001),age(OR=1.021,95%CI 1.008-1.034,P=0.001)and qPitt score(OR=1.923,95%CI 1.597-2.317,P<0.001)were independent factors of 28-day mortality risk in acute lower respiratory tract infection patients.The area under ROC curve(AUC)of the combined variable model of age,LAC and qPitt score was 0.746(95%CI 0.708-0.784),which was higher than that of LAC(AUC=0.692,95%CI 0.650-0.733)and qPitt score(AUC=0.702,95%CI 0.66

关 键 词：急性下呼吸道感染 血乳酸 年龄 快速皮特菌血症评分 死亡风险 预测模型 

分 类 号：R56[医药卫生—呼吸系统]