中国呼吸与危重监护杂志

中国呼吸与危重监护杂志

甲型流感社区获得性肺炎死亡风险预测模型的建立

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目的探索一种预测甲型流感社区获得性肺炎 30 天死亡风险的模型。方法进行多中心回顾研究分析 178 例甲型流感社区获得性肺炎,包括存活组 144 例和死亡组 34 例的病例资料。采用受试者工作特征(ROC)曲线评价各评分系统对甲型流感社区获得性肺炎 30 天死亡风险的预测能力。结果甲型流感社区获得性肺炎 30 天病死率 19.1%。肺炎严重度指数(PSI)Ⅰ~Ⅱ 和社区获得性肺炎 CURB-65 评分 0~1 分的实际病死率分别为 14.5% 和 15.7%,远高于预测病死率。Logistic 回归分析证实血尿素氮>7 mmol/L、白蛋白<35 g/L和外周血淋巴细胞<0.7×109/L 是 30 天死亡的独立危险因素。以血尿素氮>7 mmol/L(U)+白蛋白<35 g/L(A)+外周血淋巴细胞<0.7×109/L(L)组合的 UAL 作为模型预测甲型流感社区获得性肺炎 30 天死亡风险,其 ROC 曲线下面积(AUC)为 0.891,高于 CURB-65 评分(AUC=0.777,P=0.008 3)、CRB-65 评分(AUC=0.590,P<0.000 1)、PSI 分级(AUC=0.568,P=0.000 1)。结论UAL 可作为一种可靠的模型用以预测甲型流感社区获得性肺炎 30 天死亡风险。

ObjectivesTo explore a reliable and simple predictive tool for 30-day mortality of influenza A community-acquired pneumonia (CAP).MethodsA multicenter retrospective study was conducted on 178 patients hospitalized with influenza A CAP, including 144 alive patients and 34 dead patients. Receiver operating characteristic (ROC) curves were performed to verify the accuracy of severity scores as 30-day mortality predictors in the study patients.ResultsThe 30-day mortality of influenza A CAP was 19.1%. The actual mortality of PSI risk class Ⅰ-Ⅱ and CURB-65 score 0-1 were 14.5% and 15.7%, respectively, which were much higher than the predicted mortality. Logistic regression confirmed blood urea nitrogen >7 mmol/L (U), albumin <35 g/L (A) and peripheral blood lymphocyte count <0.7×10 9/L (L) were independent risk factors for 30-day mortality of influenza A CAP. The area under the ROC curve (AUC) of UAL (blood urea nitrogen >7 mmol/L+ albumin <35 g/L+ peripheral blood lymphocyte count <0.7×10 9/L) was 0.891, which was higher than CURB-65 score (AUC=0.777, P=0.008 3), CRB-65 score (AUC=0.590, P<0.000 1), and PSI risk class (AUC=0.568,P=0.000 1).ConclusionUAL is a reliable and simple predictive tool for 30-day mortality of influenza A CAP.

关键词: 甲型流感; 社区获得性肺炎; 死亡; 预测模型

Key words: Influenza A; Community-acquired pneumonia; Mortality; Predictive tool

引用本文: 陈亮, 韩秀迪, 邢西迁, 朱晓莉. 甲型流感社区获得性肺炎死亡风险预测模型的建立. 中国呼吸与危重监护杂志, 2018, 17(5): 445-449. doi: 10.7507/1671-6205.201803062 复制

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