■需要护理的老年患者的肺炎在发达国家的老龄化人群中越来越普遍,治疗是世界性的重要课题。更简单的预后指标有望改善肺炎的治疗。这个单一中心,前瞻性队列研究旨在比较B型利钠肽(BNP)的有用性,降钙素原(PCT),和A-DROP得分,据报道,这与肺炎预后相关,如吸入性肺炎(AP)。
我们纳入了在2012年1月1日至2019年7月31日期间被诊断为护理和医疗相关肺炎(NHCAP)或AP的金泽医科大学Himi市立医院收治的患者。我们收集了人口统计,临床,以及来自电子病历的实验室特征和结果数据,并计算A-DROP分数。主要结果是30天死亡率。我们使用卡方检验评估了与主要结局的相关性,Fisher精确检验,t检验,Cox回归分析,和接收器工作特性曲线分析。
■在1,215名肺炎患者中,297人符合这项研究的条件,其中37人(12%)在30天内死亡。单因素分析后,我们对BNP进行了Cox比例风险分析,PCT,A-DROP得分,白蛋白,C反应蛋白,和弥散性血管内凝血,在单因素分析中与主要结局显着相关。因此,只有BNP表现出显著的相关性(P=0.008,95%CI:1.30-6.06)。PCT(P=0.529)与A-DROP评分(P=0.107)无显著相关性。此外,我们生成了受试者工作特征曲线,以估算NHCAP和AP主要结局的BNP预后临界值.BNP预测死亡的最佳临界值为179.3pg/mL(灵敏度62.2%,特异性76.2%,负似然比0.50%,正似然比2.61%)。And,与PCT(0.67)和A-DROP评分(0.69)相比,BNP产生最高的曲线下面积(0.72)。
■BNP可能是比PCT或A-DROP评分更有用的NHCAP和AP的临床预后因子,并且应在这些治疗开始时被视为常规测试。
UNASSIGNED: Pneumonia in elderly patients who require nursing care is becoming more and more common among the aging populations of developed countries, and treatment is an important topic worldwide. A simpler prognostic indicator would be expected to improve the treatment of pneumonia. This single-center, prospective cohort study aimed to compare the usefulness of B-type natriuretic peptide (BNP), procalcitonin (PCT), and the A-DROP score, which have been reported to correlate with pneumonia prognoses, such as aspiration pneumonia (AP).
UNASSIGNED: We included patients who were admitted to the Kanazawa Medical University Himi Municipal Hospital with a diagnosis of either nursing- and healthcare-associated pneumonia (NHCAP) or AP between January 1, 2012 and July 31, 2019. We collected demographic, clinical, and laboratory characteristics and outcome data from electronic medical records, and calculated A-DROP scores. The primary outcome was 30-day mortality. We evaluated correlations with the primary outcome using the chi-square test, Fisher exact test, t-test, Cox-regression analysis, and receiver operating characteristic curve analysis.
UNASSIGNED: Of the 1,215 patients with pneumonia, 297 were eligible for the study, of whom 37 (12%) died whin 30 days. After univariate analysis, we performed Cox proportional-hazards analysis for BNP, PCT, A-DROP score, albumin, C-reactive protein, and disseminated intravascular coagulation, which were significantly correlated with the primary outcome in univariate analysis. As a result, only BNP showed a significant correlation (P=0.008, 95% CI: 1.30-6.06). No significant correlation was obtained in PCT (P=0.529) and A-DROP score (P=0.107). Furthermore, we generated receiver operating characteristic curve to estimate the prognostic cut-off values of BNP for the primary outcome of NHCAP and AP. The optimal cut-off value of BNP for predicting death was 179.3 pg/mL (sensitivity 62.2%, specificity 76.2%, negative likelihood ratio 0.50%, positive likelihood ratio 2.61%). And, BNP yielded the highest area under the curve (0.72) in comparison with PCT (0.67) and A-DROP score (0.69).
UNASSIGNED: BNP may be a more clinically useful prognostic factor for NHCAP and AP than PCT or A-DROP score, and should be considered as a routine test at the beginning of these treatments.