ABSTRACT
Objective:To construct and verify the nomogram prediction model based on inflammatory indicators, underlying diseases, etiology and the British Thoracic Society modified pneumonia score (CURB-65 score) in adults with severe community acquired pneumonia (CAP).Methods:The clinical data of 172 adult inpatients first diagnosed as CAP at Taikang Xianlin Drum Tower Hospital from January 2018 to December 2021 were divided into severe and non-severe diseases groups according to the severity of their conditions. The baseline conditions (including gender, age, past history, comorbidities and family history), clinical data (including chief symptoms, onset time, CURB-65 score), first laboratory results on admission (including whole blood cell count, liver and kidney function, blood biochemistry, coagulation function, microbiological culture results) and whether the antimicrobial therapy was adjusted according to the microbiological culture results were recorded in both groups. Univariate analysis was used to screen for differential indicators between severe and non-severe patients. After covariate analysis, multi-factor Logistic regression analysis was performed based on the Aakaike information criterion (AIC) forward stepwise regression method to rigorously search for risk factors for constructing the model. Based on the results of the multi-factor analysis, a nomogram prediction model was constructed, and the discriminatory degree and calibration degree of the model were assessed using the receiver operator characteristic curve (ROC curve) and calibration curve.Results:A total of 172 adult CAP patients were included, 48 in severe group and 124 in non-severe group. The median age was 74 (57, 83) years old, onset time was 5.0 (3.0, 10.0) days, total number of comorbidities was 3 (2, 5), including 58 cases (33.7%) with hypertension and 17 (9.9%) with heart failure, 113 (65.7%) with CURB-65 score≤1, 34 cases (19.8%) had a CURB-65 score = 2 and 25 cases (14.5%) had a CURB-65 score≥3. Univariate analysis showed that there were statistically significant differences between the two groups in age, smoking history, CURB-65 score, heart rate, onset time, total comorbidity, pathogenic microorganisms, fibrinogen (FIB), D-dimer, C-reactive protein (CRP), procalcitonin (PCT), platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Multi-factor Logistic regression analysis showed that hypertension [odds ratio ( OR) = 3.749, 95% confidence interval (95% CI) 1.411 to 9.962], heart failure ( OR = 4.616, 95% CI was 1.116 to 19.093), co-infection ( OR = 2.886, 95% CI was 1.073 to 7.760), history of smoking ( OR = 8.268, 95% CI was 2.314 to 29.537), moderate to high CURB-65 score ( OR = 4.833, 95% CI was 1.892 to 12.346), CRP ( OR = 1.012, 95% CI was 1.002 to 1.022), AST ( OR = 1.015, 95% CI was 1.001 to 1.030) were risk factors for severe CAP (all P < 0.05). The filtered indicators were included in the nomogram model, and the results showed that the area under the ROC curve (AUC) for the model to identify patients with severe adult CAP was 0.896, 95% CI was 0.840 to 0.937 ( P < 0.05), and the calibration curve showed that the predicted probability of severe CAP was in good agreement with the observed probability (Hosmer-Lemeshow test: χ2 = 6.088, P = 0.665). Conclusions:The nomogram model has a good ability to identify patients with severe adult CAP and can be used as a comprehensive and reliable clinical diagnostic tool to provide a evidence for timely intervention in the treatment of adults with severe CAP.
ABSTRACT
Objective:To investigate the predictive value of neutrophil to lymphocyte ratio (NLR) and CURB-65 score in elderly patients with community acquired pneumonia (CAP).Methods:A total of 160 elderly CAP patients who were treated in Department of Respiratory and Critical Care Medicine of the Third Affiliated Hospital of Anhui Medical University between January 2019 and March 2020 were retrospectively analyzed. According to the 30-day survival, the patients were divided into the survival group ( n=127) and the death group ( n=33). The general clinical data, blood routine, liver and kidney function, blood sodium, coagulation function, C-reactive protein and procalcitonin were collected, and NLR and CURB-65 scores were calculated. Pass t-test or χ2 test was used to compare the differences of the above indexes between the two groups, and the high-risk factors of 30-day death in elderly CAP patients were screened by multivariate Logistic regression analysis; receiver operating characteristic curve (ROC) was drawn, and the predictive value of NLR and CURB-65 score on the risk of death was analyzed. Results:Compared with the survival group, the patients in the death group were older and had a higher proportion of neurological diseases and chest tightness symptoms ( P<0.05). The total number of lymphocytes, hemoglobin, and serum albumin were significantly decreased, and the total neutrophil count, blood urea nitrogen, D-dimer, NLR, C-reactive protein, procalcitonin and CURB-65 score were significantly increased in the death group (all P <0.05). Multivariate Logistic regression analysis showed that NLR and CURB-65 score were the independent risk factors of 30-day mortality in elderly CAP patients ( P<0.01). ROC survival curve showed that the area under the curve (AUC) of NLR was 0.823 [95% CI (0.747 ~ 0.900)], the cut-off value was 8.885, and the sensitivity and specificity of prognosis were 84.8% and 74.8%. The AUC of NLR combined with CURB-65 score was 0.872 [95% CI (0.801 ~ 0.942)], the cut-off value was 0.248, and the sensitivity and specificity of prognosis were 84.8% and 84.3%. The combination of the two indexes had better prognostic value than other independent evaluation indexes. Conclusions:NLR and CURB-65 scores are high risk factors of death in elderly CAP patients. The combination of the two indicators can better predict the risk of death.
ABSTRACT
Objective To evaluate the value of procalcitonin (PCT) combined with CURB-65 score in the elderly patients with community acquired pneumonia(CAP). Methods Seventy-eight elderly patients with CAP were selected in the Emergency Department of Xuanwu Hospital Capital Medical University,After admission,blood routine, PCT, blood gas analysis and biochemical examination were given, and Acute Physiology and Chronic Health Evaluation(APACHEⅡ) and CURB-65 score were carried out. According to the prognosis,the patients were divided into death group (16 cases) and survival group (62 cases),The difference of PCT,white blood cell(WBC),CURB-65 score and APACHE Ⅱ score in the two groups were compared. The differences of area under ROC curve of APACHE II score,procalcitonin (PCT),CURB-65 score,PCT and CURB-65 score were compared. Results The PCT,CURB-65 and APACHEE Ⅱ scores of the death group and the survival group were (3. 35±1. 79) μg/L vs. (2. 05±1. 89) μg/L,(2. 06±0. 85) points vs. (1. 40±0. 99) points,(20. 50±4. 06) points vs. (14. 13+5. 63) points,respectively. There were significant differences between the two groups ( P＜0. 05) . The number of WBCs in survival group and survival group were ( 9. 90 ± 3. 04)×109/L and ( 8. 77 ± 3. 70)×109/L, respectively, with no significant difference between the two groups (P＝0. 263); the area under the ROC curve of PCT predicting death was 0. 716 (P＝0. 001),the area under the ROC curve of CURB-65 predicting death was 0. 679 ( P＝0. 005), and the area under the ROC curve of APACHE II score was 0. 836 (P＝0. 001) ,which was larger than PCT and CRUB-65 (P＜0. 05). The area under ROC curve of death predicted by PCT and CRUB-65 was 0. 775 (P＝0. 001). There was no significant difference between PCT and CRUB-65 and APACHE II (P＝0. 345) . Conclusion PCT combined with CURB-65 score can accurately and rapidly assess the condition of elderly patients with community-acquired pneumonia,and has important application value.
ABSTRACT
Objective To explore the value of a new community-acquired pneumonia severity index(CPSI) in predicting the severity and mortality of patients with community-acquired pneumonia(CAP).Methods A retrospective analysis was conducted.Patients with CAP in critical care medicine of the First People's Hospital of Chenzhou were enrolled in this study.According to whether the patients died within 28 days,patients were divided into the survival group and the death group.The difference of sex,age,vital signs,blood test,the lowest Glasgow coma score (GCS) and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score,sepsis related organ failure assessment (SOFA)score,CURB-65 (confusion,uremia,respiratory rate,BP,age 65 years) score,pneumonia severity index (PSI) score and community-acquired pneumonia severity index (CPSI) score were compared between the two groups.Logistic regression analysis was performed for the scoring systems with statistical significance in univariate analysis.The receiver operating characteristic (ROC) was drawn to analyze the prognostic value of each scoring system.Results Totally 283 patients were enrolled in this study (184 survivals and 99 deaths,mortality rate 35％).Univariate analysis showed that age,mechanical ventilation (MV) ratio,the fastest heart beat rate (HR),the lowest systolic blood pressure (SBP),the lowest mean blood pressure (MAP),pressure adjusted shock index (PASI),inspired oxygen concentration (FiO2),arterial oxygen partial pressure (PaO2),and oxygenation index (PO2/FiO2),blood urea nitrogen concentration (BUN),serum creatinine concentration (Scr),urine output,length of ICU stay,the lowest GCS,and APACHE Ⅱ score were significantly different between the two groups (P＜0.05).Multivariate regression analysis showed that CPSI score and SOFA score were independent risk factors for patients with CAP.The ROC curve of CAP patients was predicted in each scoring system,and the area under the ROC curve of CPSI score (0.728),SOFA and age score (0.708),PSI score (0.701),APACHE Ⅱ score (0.690),CURB-65 score (0.687) and SOFA score (0.683) gradually decreased.The sensitivity and specificity of the area under curve prediction showed that CPSI score was superior to the other scores.Conclusions The CPSI score can evaluate the severity of CAP patients,efficiently predict the outcome of patients with CAP,and can be widely used in clinical practice.
ABSTRACT
Objective To evaluate the prognosis of patients with sepsis in the emergency department using the modified CURB-65 score.Methods We retrospectively analyzed the clinical data of 143 patients with sepsis who were first diagnosed at the emergency department of the First Hospital of China Medical University (between January 2014 and January 2015),assessed their CURB-65 and sequential organ failure assessment (SOFA) scores,and modified the CURB-65 scoring system by adding some indexes of the prognosis of sepsis.We analyzed the prognostic value of each scoring systems in the diagnosis of sepsis using the receiver-operating characteristic curve.Results The modified CURB-65,CURB-65,and SOFA scores had independent abilities for early prediction of the prognosis of sepsis.The area under the curve and the Youden index of the modified CURB-65 score were highest,which are superior to the traditional CURB-65 and SOFA scores.Conclusion The modified CURB-65 score can predict the prognosis of sepsis in its early stage.In addition,the assessment method is simple and convenient;hence,it is useful for assessing the condition of patients with sepsis and providing an early treatment.
ABSTRACT
Objective To evaluate the clinical application value of modified CURB-65 score for assessing severity of community-acquired pneumonia (CAP) in emergency patients.Methods During the period from May 2011 to May 2012,198 emergency patients with CAP enrolled in this study were evaluated by CURB-65 score and modified CURB-65 score,respectively.Based on the severity of CAP,patients were divided into mild pneumonia group (Group A,n =107) and severe pneumonia group (Group B,n =91).The clinical status and biomarkers (the white blood cell count,procalcitonin,pneumonia severity index,hospitalization days,and hospitalization expenses) were recorded and compared with t test.Group B was divided into survived-subgroup (n =62) and death-subgroup (n =29).The differences in CURB-65 score and modified CURB-65 scere between the two groups were compared with t test.The correlation of CURB-65 score and modified CURB-65 score with procalcitonin,pneumonia severity index,hospitalization days,and hospitalization expenses were determined with Pearson rank correlation method.Results The procalcitonin,pneumonia severity index,hospitalization days,hospitalization expenses,modified CURB-65 score and CURB-65 score in Group B were significantly higher than those in Group A [(3.70 ± 0.83) vs.(1.27±0.24),t=28.91,P＜0.01; (121.33±16.74) vs.(73.79±9.21),t=25.23,P＜0.01;(25.79±10.13) vs.(14.85 ±6.83),t=9.02,P＜0.01; (22.71 ±3.84) vs.(9.83 ±1.24),t=32.76,P＜0.01; (3.69±1.03) vs.(3.32±1.06),t=2.48,P＜0.05; (4.21±1.13) vs.(3.41±0.96),t =5.39,P＜0.01],while no significant difference was observed in the white blood cell count between GroupA and B (17.58 ±5.99 vs.16.86±4.41,t =0.97,P＞0.05).For Group B,the modified CURB-65 score of death-subgroup was significantly higher than that of survived-subgroup [(4.75± ± 1.17) vs.(4.01 ± 1.09),t =2.95,P ＜ 0.01],whilc no significant difference was observed in the CURB-65 score between the death-subgroup and survived-subgroup (4.01 ± 1.15 vs.3.58 ±0.97,t =1.86,P ＞ 0.05).The CURB-65 score positive correlated with the procalcitonin (r =-0.803,P =0.025),and had no obvious correlation with the pneumonia severity index,hospitalization days,and hospitalization expenses (r=0.621,P=0.320; r=0.701,P=0.231; r=0.675,P=0.256); The modified CURB-65 score significantly positively correlated with the procalcitonin,pneumonia severity index,hospitalization days,and hospitalization expenses (r =0.951,P =0.003 ; r =0.965,P =0.002 ; r =0.947,P =0.004 ; r =0.961,P =0.002).Conclusions Compared with the CURB-65 score,the modified CURB-65 score is more efficient in evaluating the severity and prognoses of CAP for emergency patients.
ABSTRACT
Objective To investigate the change and clinical significance of serum procalcitonin (PCT) level in patients with community-acquired pneumonia (CAP).Methods One hundred and forty-five CAP patients were enrolled.Serum PCT level was measured by immunofluorescent antibody staining method.CURB-65 score and pneumonia severity index (PSI) score were used to evaluate the severity of the patients with CAP.Correlations between PCT and blood white blood cell (WBC) count,serum C-reactive protein (CRP),PSI score,CURB-65 score,hospitalization duration and mortality were analyzed with Pearson correlation analysis,Logistic regression analysis and so on.Results Serum PCT in patients with CAP showed positively correlated with CURB-65 score and PSI score (r =0.606,0.943,P＜ 0.01 ),and serum PCT was also positively correlated with age,serum CRP and hospitalization duration (r =0.753,0.233,0.281,P ＜0.01),but it wasn't correlated with blood WBC count (r =0.152,P ＞0.05).Logistic regression analysis showed that each increment of 1 μ g/L for serum PCT would increase 2.828-fold for the risk of death in CAP patients.Conclusions Serum PCT predicts the sensitivity and specificity of CAP with a similar prognostic accuracy with CURB-65 score and PSI score.Serum PCT in patients with CAP correlates with hospitalization duration and mortality.Therefore,it is a promising prognostic marker to evaluate the severity and outcome of CAP.It may serve as a useful marker for clinicians to evaluate the severity and prognosis of CAP.
ABSTRACT
Objective To evaluatethe clinical value of procalcitonin(PCT)in the diagnosis and assessment of community-acquired pneumonia(CAP).Methods Ninety-six patients with CAP(CAP group)who hospitahzed during the period of November 2005 to August 2006 were admitted.Meanwhile,30 people were taken as control group.The levels of PCT,CRP and WBC were detected on the next day and the 8th day of hospitalization.Results(1)The receiver operating characteristic(ROC)curve was made through setting the threshold value of PCT,CRP and WBC as 1.5 μg/L,10 md/L and 10×109/L respectively in AP group and control group.The RFea undering ROC curve was 0.979.0.831 and 0.736 respectively.(2) The mean value of PCT in the patients of bacterial pneumonia.atypical pathogen pneumonia and viral pneumonia was(9.74±6.20),(7.81±5.70)and(12.20±6.50)μg/L respectively.There were no statistical differences in those patients.(3)There was correlation between PCT and CURB-65 score(r=0.258.P=0.011).The value of serum PCT showed significant differences in the patients with mild pneumonia.moderate pneumonia and severe pneumonia. Conclusions Serum PCT has higher sensitivity and specificity than CRP and WBC in the diagnosis of CAP.There is correlation between PCT and the severity of CAP,so it indicates that PCT has a certain practical value in the iudgement of the condition of CAP.