Amit Pravin Chauhan, Aarjuv Majmundar, S. Lakhani, Jitendra Lakhani
{"title":"社区获得性肺炎患者入住重症监护室和死亡率的预测因素--Curb-65 和 Psi/port 评分的比较研究","authors":"Amit Pravin Chauhan, Aarjuv Majmundar, S. Lakhani, Jitendra Lakhani","doi":"10.18231/j.ijca.2024.036","DOIUrl":null,"url":null,"abstract":"Despite recent advances in clinical medicine, mortality due to CAP has remained relatively the same. Therefore, early recognition for ICU admission plays a pivotal role in management of CAP. PSI/PORT (Pneumonia Severity Index/ Pneumonia Patient Outcome Research Team) score and CURB-65 (Confusion, Uremia, Respiratory rate, BP, Age > 65 years) are the two severity assessment scores that have extensively been used by the clinicians to distinguish between high risk and low risk patients. This study aims at comparing the predictive value of these two scores for ICU admission and mortality. The information required for calculating CURB-65 and PSI was extracted with careful history taking, patient assessment and necessary investigations. Patients with >18 years of age, diagnosed clinically and radiologically with CAP were included in the study.CURB-65 and PSI scores were determined in a total of 131 patients on admission. Based on careful clinical assessment and judgment of treating physician 60 patients were admitted in ICU whereas 71 patients were admitted in medical ward. Out of 60 patients admitted in ICU 23 died. The ability to predict ICU admission was almost similar for PSI/PORT score (AUC 0.9605; 95% CI 0.9277-0.9933) and CURB-65 (AUC 0.9694; 95% CI 0.9368-1.9714). The ability to predict mortality was almost similar for PSI/PORT score (AUC 0.9196; 95% CI 0.8670-0.9722) and CURB-65 (AUC 0.9214 95% CI 0.8696-0.9732). CURB-65 score was found almost similar in predicting ICU admission amongst patients coming with CAP to our hospital when compared to PSI/PORT score and when predicting mortality in patients with community-acquired pneumonia, CURB-65 and PSI/PORT score appear to have comparable specificity and sensitivity. Considering the simplicity, CURB-65 score could be preferred over PSI/PORT score. However, larger studies are required to know the exact Indian scenario. Despite of recent advances in the field of medical science the mortality due to CAP has remained relatively the same. Therefore, early diagnosis and admission to ICU with standard treatment play a pivot role in management of patients with CAP. Two scoring system, PSI/PORT score and CURB-65 score, are widely being used to differentiate between low risk and high risk patients. We undertook this study for comparing the predictive value of these two scores for ICU admission and mortality.","PeriodicalId":13310,"journal":{"name":"Indian Journal of Clinical Anaesthesia","volume":"10 5","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2024-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"A comparative study between curb-65 and psi/port score as predictors for ICU admission and mortality in community acquired pneumonia patients presenting to a tertiary care hospital\",\"authors\":\"Amit Pravin Chauhan, Aarjuv Majmundar, S. Lakhani, Jitendra Lakhani\",\"doi\":\"10.18231/j.ijca.2024.036\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Despite recent advances in clinical medicine, mortality due to CAP has remained relatively the same. Therefore, early recognition for ICU admission plays a pivotal role in management of CAP. PSI/PORT (Pneumonia Severity Index/ Pneumonia Patient Outcome Research Team) score and CURB-65 (Confusion, Uremia, Respiratory rate, BP, Age > 65 years) are the two severity assessment scores that have extensively been used by the clinicians to distinguish between high risk and low risk patients. This study aims at comparing the predictive value of these two scores for ICU admission and mortality. The information required for calculating CURB-65 and PSI was extracted with careful history taking, patient assessment and necessary investigations. Patients with >18 years of age, diagnosed clinically and radiologically with CAP were included in the study.CURB-65 and PSI scores were determined in a total of 131 patients on admission. Based on careful clinical assessment and judgment of treating physician 60 patients were admitted in ICU whereas 71 patients were admitted in medical ward. Out of 60 patients admitted in ICU 23 died. 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Therefore, early diagnosis and admission to ICU with standard treatment play a pivot role in management of patients with CAP. Two scoring system, PSI/PORT score and CURB-65 score, are widely being used to differentiate between low risk and high risk patients. 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引用次数: 0
摘要
尽管近年来临床医学不断进步,但 CAP 导致的死亡率却相对保持不变。因此,早期识别并送入重症监护室在 CAP 的治疗中起着至关重要的作用。PSI/PORT(肺炎严重程度指数/肺炎患者结局研究小组)评分和 CURB-65(意识模糊、尿毒症、呼吸频率、血压、年龄大于 65 岁)是临床医生广泛使用的两种严重程度评估评分,用于区分高危和低危患者。本研究旨在比较这两个评分对入住重症监护病房和死亡率的预测价值。计算 CURB-65 和 PSI 所需的信息是通过仔细询问病史、评估患者和进行必要的检查提取的。共对 131 名入院患者进行了 CURB-65 和 PSI 评分。根据仔细的临床评估和主治医生的判断,60 名患者入住重症监护室,71 名患者入住内科病房。在入住重症监护室的 60 名患者中,有 23 人死亡。PSI/PORT 评分(AUC 0.9605;95% CI 0.9277-0.9933)和 CURB-65 评分(AUC 0.9694;95% CI 0.9368-1.9714)预测入住 ICU 的能力几乎相似。PSI/PORT 评分(AUC 0.9196;95% CI 0.8670-0.9722)和 CURB-65 评分(AUC 0.9214 95% CI 0.8696-0.9732)预测死亡率的能力几乎相似。与 PSI/PORT 评分相比,我们发现 CURB-65 评分在预测本院 CAP 患者入住 ICU 的情况方面与 PSI/PORT 评分几乎相似,而在预测社区获得性肺炎患者的死亡率方面,CURB-65 和 PSI/PORT 评分似乎具有相似的特异性和敏感性。考虑到简便性,CURB-65 评分可能比 PSI/PORT 评分更受青睐。不过,要了解印度的具体情况,还需要进行更大规模的研究。尽管最近医学领域取得了进步,但 CAP 导致的死亡率仍然相对较低。因此,早期诊断和入住重症监护室并接受标准治疗在 CAP 患者的管理中起着关键作用。PSI/PORT 评分和 CURB-65 评分这两种评分系统被广泛用于区分低风险和高风险患者。我们进行了这项研究,以比较这两种评分对入住重症监护室和死亡率的预测价值。
A comparative study between curb-65 and psi/port score as predictors for ICU admission and mortality in community acquired pneumonia patients presenting to a tertiary care hospital
Despite recent advances in clinical medicine, mortality due to CAP has remained relatively the same. Therefore, early recognition for ICU admission plays a pivotal role in management of CAP. PSI/PORT (Pneumonia Severity Index/ Pneumonia Patient Outcome Research Team) score and CURB-65 (Confusion, Uremia, Respiratory rate, BP, Age > 65 years) are the two severity assessment scores that have extensively been used by the clinicians to distinguish between high risk and low risk patients. This study aims at comparing the predictive value of these two scores for ICU admission and mortality. The information required for calculating CURB-65 and PSI was extracted with careful history taking, patient assessment and necessary investigations. Patients with >18 years of age, diagnosed clinically and radiologically with CAP were included in the study.CURB-65 and PSI scores were determined in a total of 131 patients on admission. Based on careful clinical assessment and judgment of treating physician 60 patients were admitted in ICU whereas 71 patients were admitted in medical ward. Out of 60 patients admitted in ICU 23 died. The ability to predict ICU admission was almost similar for PSI/PORT score (AUC 0.9605; 95% CI 0.9277-0.9933) and CURB-65 (AUC 0.9694; 95% CI 0.9368-1.9714). The ability to predict mortality was almost similar for PSI/PORT score (AUC 0.9196; 95% CI 0.8670-0.9722) and CURB-65 (AUC 0.9214 95% CI 0.8696-0.9732). CURB-65 score was found almost similar in predicting ICU admission amongst patients coming with CAP to our hospital when compared to PSI/PORT score and when predicting mortality in patients with community-acquired pneumonia, CURB-65 and PSI/PORT score appear to have comparable specificity and sensitivity. Considering the simplicity, CURB-65 score could be preferred over PSI/PORT score. However, larger studies are required to know the exact Indian scenario. Despite of recent advances in the field of medical science the mortality due to CAP has remained relatively the same. Therefore, early diagnosis and admission to ICU with standard treatment play a pivot role in management of patients with CAP. Two scoring system, PSI/PORT score and CURB-65 score, are widely being used to differentiate between low risk and high risk patients. We undertook this study for comparing the predictive value of these two scores for ICU admission and mortality.