论文部分内容阅读
【摘要】 目的 探討老年人营养风险评分（GNRI）联合临床肺部感染评分（CPIS）及感染指标在老年社区获得性肺炎（CAP）患者中的预后评估价值。方法 收集237例老年CAP住院患者，以GNRI 92分、CPIS 6分为界限，将患者分为GNRI < 92分、CPIS≥6分组（A组，61例），GNRI < 92分、CPIS < 6分组（B组，65例），GNRI≥92分、CPIS≥6分组（C组，54例），GNRI≥92分、CPIS < 6分组（D组，57例）。比较各组老年CAP患者的住院时间、机械通气率、住院期间病死率、年龄、吸烟史及基础疾病（高血压、冠状动脉粥样硬化性心脏病、2型糖尿病、肾功能不全）、入院时降钙素原（PCT）和CRP。采用受试者工作特征（ROC）曲线对比GNRI+CPIS和GNRI+CPIS联合CRP+PCT对老年CAP患者预后的预测价值。结果 4组老年CAP患者的年龄、吸烟史、存在基础疾病及住院时间比较差异均无统计学意义（P均> 0.05），4组的机械通气率、住院期间病死率、CRP、PCT比较差异均有统计学意义（P均< 0.05）。GNRI+CPIS联合评分预测老年CAP患者死亡风险的ROC AUC为0.805、灵敏度为0.975、特异度为0.847;GNRI+CPIS联合CRP+PCT预测老年CAP患者住院期间死亡风险的ROC AUC为0.897，灵敏度为0.983，特异度为0.906;GNRI+CPIS联合CRP+PCT模型的预测价值高于GNRI+CPIS联合评分（P < 0.001）。结论 GNRI+CPIS联合CRP+PCT共同预测老年CAP住院期间病死率的价值高于GNRI+CPIS。
【关键词】 老年营养风险评分;临床肺部感染评分;降钙素原;社区获得性肺炎;预后
Prognostic value of GNRI， CPIS combined with inflammatory markers in elderly patients with community-acquired pneumonia Chen Jiaqi， Wu Jun， Ye Guohui， Liang Junbin， Xiao Wanmei. Guangdong Medical University， Zhanjiang 524000， China
Corresponding author， Wu Jun， E-mail： 630206063@ qq. com
【Abstract】 Objective To evaluate the prognostic value of geriatric nutritional risk index （GNRI） combined with clinical pulmonary infection score （CPIS） and inflammatory markers in elderly patients diagnosed with community-acquired pneumonia （CAP）. Methods A total of 237 elderly patients with CAP were recruited and divided into the following 4 groups： GNRI<92 and CPIS≥6 group （A group， n = 61）， GNRI<92 and CPIS<6 group （B group， n = 65）， GNRI≥92 and CPIS≥6 group （C group， n = 54） and GNRI≥92 and CPIS<6 group （D group， n = 57） according to the limits of GNRI≥92 and CPIS≥6. The length of hospital stay， mechanical ventilation rate， mortality rate， age， smoking history and underlying diseases （hypertension， coronary atherosclerotic heart disease， type 2 diabetes mellitus and renal insufficiency）， procalcitonin （PCT） and C-reactive protein （CRP） levels upon admission were statistically compared among different groups. The receiver operating characteristic （ROC） curve was delineated to compare the area under the ROC curve （AUC）， sensitivity and specificity of GNRI+CPIS and GNRI+CPIS+CRP+PCT in predicting the clinical prognosis of CAP patients. Results Age， smoking history and underlying diseases and length of hospital stay did not significantly differ among the 4 groups （all P > 0.05）. The mechanical ventilation rate， mortality rate， CRP and PCT significantly differed among the 4 groups （all P < 0.05）. The area under curve（AUC）， sensitivity and specificity of the combined score of GNRI+CPIS in predicting the risk of death in elderly patients with CAP was 0.805， 0.975 and 0.847， respectively. The AUC， sensitivity and specificity of GNRI+CPIS+CRP+PCT in predict the risk of death in elderly patients with CAP was 0.897， 0.983 and 0.906， respectively. The predictive value of the GNRI+CPIS+CRP+PCT model was significantly higher than that of the combined score of GNRI+CPIS （P < 0.001）. Conclusion Compared with GNRI+CPIS， GNRI+CPIS+CRP+PCT is more efficiency in predicting clinical prognosis of elderly patients with CAP.
【关键词】 老年营养风险评分;临床肺部感染评分;降钙素原;社区获得性肺炎;预后
Prognostic value of GNRI， CPIS combined with inflammatory markers in elderly patients with community-acquired pneumonia Chen Jiaqi， Wu Jun， Ye Guohui， Liang Junbin， Xiao Wanmei. Guangdong Medical University， Zhanjiang 524000， China
Corresponding author， Wu Jun， E-mail： 630206063@ qq. com
【Abstract】 Objective To evaluate the prognostic value of geriatric nutritional risk index （GNRI） combined with clinical pulmonary infection score （CPIS） and inflammatory markers in elderly patients diagnosed with community-acquired pneumonia （CAP）. Methods A total of 237 elderly patients with CAP were recruited and divided into the following 4 groups： GNRI<92 and CPIS≥6 group （A group， n = 61）， GNRI<92 and CPIS<6 group （B group， n = 65）， GNRI≥92 and CPIS≥6 group （C group， n = 54） and GNRI≥92 and CPIS<6 group （D group， n = 57） according to the limits of GNRI≥92 and CPIS≥6. The length of hospital stay， mechanical ventilation rate， mortality rate， age， smoking history and underlying diseases （hypertension， coronary atherosclerotic heart disease， type 2 diabetes mellitus and renal insufficiency）， procalcitonin （PCT） and C-reactive protein （CRP） levels upon admission were statistically compared among different groups. The receiver operating characteristic （ROC） curve was delineated to compare the area under the ROC curve （AUC）， sensitivity and specificity of GNRI+CPIS and GNRI+CPIS+CRP+PCT in predicting the clinical prognosis of CAP patients. Results Age， smoking history and underlying diseases and length of hospital stay did not significantly differ among the 4 groups （all P > 0.05）. The mechanical ventilation rate， mortality rate， CRP and PCT significantly differed among the 4 groups （all P < 0.05）. The area under curve（AUC）， sensitivity and specificity of the combined score of GNRI+CPIS in predicting the risk of death in elderly patients with CAP was 0.805， 0.975 and 0.847， respectively. The AUC， sensitivity and specificity of GNRI+CPIS+CRP+PCT in predict the risk of death in elderly patients with CAP was 0.897， 0.983 and 0.906， respectively. The predictive value of the GNRI+CPIS+CRP+PCT model was significantly higher than that of the combined score of GNRI+CPIS （P < 0.001）. Conclusion Compared with GNRI+CPIS， GNRI+CPIS+CRP+PCT is more efficiency in predicting clinical prognosis of elderly patients with CAP.