Preliminary study on the value of the new community acquired pneumonia severity index

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. Key words: Community-acquired pneumonia; Pneumonia severity index; CURB-65 score; Acute physiology and chronic health evaluation Ⅱ; Sepsis related organ failure assessment; Shock index; Receiver operating characteristic curve; Early goal guiding treatment