CORB(神志不清、氧合、呼吸频率和血压)量表在预测肺炎临床结局中的应用

IF 2.1 4区 医学 Q3 RESPIRATORY SYSTEM Canadian respiratory journal Pub Date : 2022-06-03 DOI:10.1155/2022/4493777
L. Reyes, A. Bastidas, Eduardo Tuta Quintero, Juan S. Frías, Á. F. Aguilar, Karen D Pedreros, Manuela Herrera, Laura D Saza, Alejandra P Nonzoque, Laura E Bello, M. D. Hernández, Germán A Carmona, Anyelinne Jaimes, Silvia M Ramírez, Natalia Murillo
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An alternative CORB score was estimated by replacing SpO2 ≤90% by the SpO2/FiO2 ratio. Crude and adjusted odd ratios (AOR) were calculated for each variable. The area under the receiver operating characteristics curve (AUROC) was constructed for each score, and outcomes were analyzed. AUROCs were compared with the DeLong test, considering a p value <0,05 statistically significant. Results From 1,811 subjects who entered the analysis, 15.1% (273/1,811) died in hospital, 8.78% required IMV (159/1,811), and 9.77% (177/1,811) needed vasopressor support. CORB had an AUROC of 0,660 (95% CI: 0,623–0,697) for in-hospital mortality; an AUROC of 0,657 (95% CI: 0,621–0,692) for 30-day mortality; an AUROC of 0,637 (CI 95%: 0,589–0,685) for IMV requirement; and an AUROC of 0,635 (95% CI: 0,589–0,681) for vasopressor support. CORB performance increases when the SpO2/FiO2 ratio <300 is used as oxygenation criterion in the prediction of requirement for IMV and vasopressor support, with AUROC of 0,700 (95% CI: 0,654–0,746; p < 0.001) and AUROC of 0,702 (95% CI: 0,66–0,745; p < 0.001), respectively. CURB-65 score presents an in-hospital mortality AUROC of 0,727 (95% CI: 0,695–0,759) and 30-day mortality AUROC of 0,726 (95% CI: 0,695–0,756). Conclusions CORB score has a good performance in predicting the need for IMV and vasopressor support in CAP patients. This performance improves when the SpO2/FiO2 ratio <300 is used instead of the SpO2 ≤90% as the oxygenation parameter. 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引用次数: 0

摘要

社区获得性肺炎(CAP)是一种常见的发病和死亡原因,主要是由于误诊和治疗方法不当。目的评价CORB评分对CAP患者住院死亡率、入院30天内死亡、有创机械通气(IMV)和血管加压素支持需求的预测作用。方法采用回顾性队列研究,根据ATS标准对CAP患者的CORB和CURB-65评分进行诊断测试分析。用SpO2/FiO2比率代替SpO2≤90%来估计另一种CORB评分。计算每个变量的原始和调整后的奇数比(AOR)。为每个评分构建受试者工作特征曲线下面积(AUROC),并对结果进行分析。auroc与DeLong检验比较,认为p值< 0.05具有统计学意义。结果纳入分析的1811名受试者中,15.1%(273/ 1811)在医院死亡,8.78%(159/ 1811)需要IMV, 9.77%(177/ 1811)需要血管加压药物支持。CORB对住院死亡率的AUROC为0,660 (95% CI: 0,623-0,697);30天死亡率AUROC为0,657 (95% CI: 0,621-0,692);IMV需求的AUROC为0.637 (CI 95%: 0.589 - 0.685);血管加压剂支持的AUROC为0.635 (95% CI: 0.589 - 0.681)。当SpO2/FiO2比值<300作为预测IMV和血管加压素支持需求的氧合标准时,CORB性能增加,AUROC为0,700 (95% CI: 0,654-0,746;p < 0.001), AUROC为0,702 (95% CI: 0,66 - 0,745;P < 0.001)。CURB-65评分显示住院死亡率AUROC为0.727 (95% CI: 0.695 - 0.759), 30天死亡率AUROC为0.726 (95% CI: 0.695 - 0.756)。结论CORB评分能较好地预测CAP患者对IMV和血管加压素支持的需求。当采用SpO2/FiO2 <300而不是SpO2≤90%作为氧化参数时,性能有所提高。CURB-65评分在预测死亡率方面具有优势。
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Performance of the CORB (Confusion, Oxygenation, Respiratory Rate, and Blood Pressure) Scale for the Prediction of Clinical Outcomes in Pneumonia
Background Community-acquired pneumonia (CAP) is a common cause of morbidity and mortality due to misdiagnosis and inappropriate treatment approaches. Objective To assess the performance of the CORB score in subjects with CAP for predicting in-hospital mortality, death within 30 days of admission, and requirement for invasive mechanical ventilation (IMV) and vasopressor support. Methods A retrospective, cohort study with diagnostic test analysis of CORB and CURB-65 scores in subjects with CAP according to ATS criteria was undertaken. An alternative CORB score was estimated by replacing SpO2 ≤90% by the SpO2/FiO2 ratio. Crude and adjusted odd ratios (AOR) were calculated for each variable. The area under the receiver operating characteristics curve (AUROC) was constructed for each score, and outcomes were analyzed. AUROCs were compared with the DeLong test, considering a p value <0,05 statistically significant. Results From 1,811 subjects who entered the analysis, 15.1% (273/1,811) died in hospital, 8.78% required IMV (159/1,811), and 9.77% (177/1,811) needed vasopressor support. CORB had an AUROC of 0,660 (95% CI: 0,623–0,697) for in-hospital mortality; an AUROC of 0,657 (95% CI: 0,621–0,692) for 30-day mortality; an AUROC of 0,637 (CI 95%: 0,589–0,685) for IMV requirement; and an AUROC of 0,635 (95% CI: 0,589–0,681) for vasopressor support. CORB performance increases when the SpO2/FiO2 ratio <300 is used as oxygenation criterion in the prediction of requirement for IMV and vasopressor support, with AUROC of 0,700 (95% CI: 0,654–0,746; p < 0.001) and AUROC of 0,702 (95% CI: 0,66–0,745; p < 0.001), respectively. CURB-65 score presents an in-hospital mortality AUROC of 0,727 (95% CI: 0,695–0,759) and 30-day mortality AUROC of 0,726 (95% CI: 0,695–0,756). Conclusions CORB score has a good performance in predicting the need for IMV and vasopressor support in CAP patients. This performance improves when the SpO2/FiO2 ratio <300 is used instead of the SpO2 ≤90% as the oxygenation parameter. CURB-65 score is superior in the prediction of mortality.
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来源期刊
Canadian respiratory journal
Canadian respiratory journal 医学-呼吸系统
CiteScore
4.20
自引率
0.00%
发文量
61
审稿时长
6-12 weeks
期刊介绍: Canadian Respiratory Journal is a peer-reviewed, Open Access journal that aims to provide a multidisciplinary forum for research in all areas of respiratory medicine. The journal publishes original research articles, review articles, and clinical studies related to asthma, allergy, COPD, non-invasive ventilation, therapeutic intervention, lung cancer, airway and lung infections, as well as any other respiratory diseases.
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