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
Prognostic value of admission blood lactate level combined with severe score in patients with community-required pneumonia

史茹梦.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[J].内科急危重症杂志,2019,25(3):198-201

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DOI：10.11768/nkjwzzzz20190307

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作者	单位	E-mail
史茹梦	河北大学医学院	yangwh666@163.com

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中文摘要:

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8h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% CI0.707~0.876）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。

英文摘要:

Objective: To explore the prognostic value of admission blood lactate level combined with qSOFA and CRB/CURB-65 scores in patients with community-acquired pneumonia. Methods: 512 patients with community-acquired pneumonia whose blood lactate level was measured within 8h after admission were enrolled in the retrospective study. They all had qSOFA and CRB/CURB-65 scores. With receiver-operating characteristic curves, we compared the ability of these scores to predict poor prognosis, and got the cutoff. The main outcome endpoint was the combination of need for mechanical ventilation, vasopressors, or hospital mortality. Results: All three scoring systems showed the higher the scores, the higher the poor prognosis rate: qSOFA (19.4%, 45.5%, 50%), CRB-65 (10.7%, 45.2%, 66.7%), CURB-65 (11.1%, 23.5%, 47.6%, 100%). The CURB-65 (0.791, 95% CI 0.707-0.876) had the highest predictive value for poor prognosis in patients with community-acquired pneumonia. After adding lactate, the predictive value of CRB-65 (0.761 vs 0.795), CURB-65 (0.791 vs 0.835) and qSOFA (0.770 vs 0.837) was improved, and the qSOFA made a fortune. Conclusion: Although the CURB-65 has the better predictive value for short-term poor prognosis than qSOFA and CRB-65 in patients with community-acquired pneumonia, the qSOFA score can be more effective after adding lactate, and may be beneficial for diagnosing critically ill patients.