Compared With CL And CPIS In The Diagnosis Of Pneumonia

Objective: Pneumonia in Intensive Care Unit is a very common disease.Its incidence increased year by year in recent years,illness development is rapid,along with the increasing of length of hospital stay and cost,even life threatening.Early,ccurate and rapid diagnosing of pneumonia is very important.Chest X-ray Radiography(CXR)and CT are traditional methods of imaging in the diagnosis of pneumonia.CXR`s sesitivity and specificity of diagnosing pneumonia were low,the condition of the missed diagnosis and misdiagnosis often exist.CT is the gold standard in the diagnosis of pneumonia.Its accuracy is higher,but often associated with patient transport difficulties.It is also not conducive to dynamic monitoring.CXR and CT have the disadvantage of high radiation.This study introduced the rapid development of Lung ultrasound(LUS)in recent years and Clinical Pulmonary Infection Score(CPIS)what are used for the accuracy of diagnosis of pneumonia.2005 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society and CT are standard in the diagnosis of pneumonia.CXR of CPIS score is replaced with ultrasound,which is known as the CL score.The sensitivity,specificity,positive predictive value,negative predictive value of CL,CL+PCT,CPIS and CPIS+PCT when diagnosoing of pneumonia will be analysisd.Looking for the diagnosis of pneumonia most correct method,so as to guide the early diagnosis and treatment of pneumonia.Methods: This study collected in January 2016 to December 2016 in hebei province people's hospital of intensive medicine suspected patients with pneumonia,according to the inclusion and exclusion standard filtered all collectors.All suspected in patients with pneumonia were performed lung ultrasound examination after the bedside,both lungs can be divided into 6areas,sternal Angle plane and axial plane human body will be divided into two areas of the chest.Every district is bounded and axillary in axils of the front line again will each divided into before,during and after the three zones.With three steps to check:(1)the patient supine,scan of 2 areas of anterior chest wall,observing the pleura and subpleural lesions;(2)the patient supine,scan range of anterior chest wall to the lateral wall,in the middle lung field lateral chest wall scan,observe the presence of pleural effusion and pulmonary consolidation;(3)Raise the patients on the same side body and scan back lung field,further exploration areas of consolidation of the pleural effusion and small pieces.Completing the examination by a physician who has been trained by intensive ultrasound,and consummates the lung CT examination within 24 hours.Vader PCT application processing machine processing patients blood samples.Another physician of icu according patients with clinical data to calculate the CPIS.The images observed by bed lung ultrasound includ:normal reflection with gas inside in the lungs and pathological changes,the scope of consolidation of the lung,the areas of consolidation of the lung,the subpleural lesions,pleural change.All those images are observed and record as a result,citing LUS score concept,carried out in accordance with the pulmonary lesion severity classification score: ?2areas with subpleural consolidations or Pleural thickening,1 point;.?1 areas with consolidation of the lung or dynamic arborescent/linear air bronchogram,2 points;Two kinds of circumstances exist at the same time,3 points.According China expert consensus emergency clinical application to grade of the PCT: PCT < 0.5 ng/ml,0 points;0.5?PCT< 2 ng/ml,1 points.PCT?2 ng/ml,2 points.CXR of CPIS score is replaced with ultrasound,which is known as the CL score.The sensitivity,specificity,positive predictive value,negative predictive value of CL,CL+PCT,CPIS and CPIS+PCT when diagnosing of pneumonia will be analyzed and drawed receiver-operating characteristic curves.The area under the curve for the CL+PCT,CL,CPIS+PCT,CPIS will be analyzed.Results: A total of 72 suspected Patients with pneumonia included inthis study,52 patients with pneumonia confirmed by the gold standard,20 cases of patients without pneumonia including 1 patient with pneumothoraxs,10 patients with pleural effusion,9 cases of patients with acute respiratory distress syndrome.Two groups of patients with significant differences in clinical characteristics of PCT,purulent secretion,respectively.There were not having significant differences in major clinical features: gender,age,SOFA score,APACHEII scores,body mass index,shock or not,length of hospital stay,mortality.The only significant difference parameters for the two groups of patients was PCT(7.91(0.13-100)and 1.62(0.17-4.50),P=0.041.When patients were performed with lung ultrasound can detect(consolidation or dynamic arborescent)and(pleural thickening or subpleural lesions of two or more conditions)exist at the same time,the accuracy of the diagnosis of pneumonia was up to 100%.When comparing of CPIS,CPIS+PCT,CL and CL+PCT which were predictors of pneumonia diagnosis,there were not having significant differences.(P>0.05).The four diagnosis of pneumonia methods were effective.Receiver-operating characteristic curves comparing different scores:CL+PCT,CL,CPIS+PCT,CPIS.The area under the curve for the CL+PCT,CL,CPIS+PCT,CPIS were 0.925,0.913,0.788,0.726 respectively.The area under the curve(order from large to small was:CL+PCT,CL,CPIS+PCT,CPIS(P < 0.05).CPIS,PCT+CPIS for the diagnostic of pneumonia: The sensitivity,specificity,positive predictive value,negative predictive value of of CPIS?6for the diagnosis of pneumonia was 71.2%,55%,80.4%? 42.3% respectively.The sensitivity,specificity,positive predictive value,negative predictive value of CPIS+PCT?6 for the diagnosis of pneumonia was 90.3%,50%,82.4%,66.7%.Only CPIS+PCT?10 had 100% accuracy of specificity,positive predictive value for the diagnosis of pneumonia.CL,PCT+CL for the diagnostic of pneumonia: The sensitivity,specificity,positive predictive value,negative predictive value of of CL?6 for the diagnosis of pneumonia was 88.5%,75%,90.2% and 71.4% respectively.Thesensitivity,specificity,positive predictive value,negative predictive value of CPIS+PCT?6 for the diagnosis of pneumonia was 96.2%,86.2%,60%,85.7%.Only CL+PCT?9,10 had 100% accuracy of specificity,positive predictive value for the diagnosis of pneumonia.Conclusions:1 In the image information,the accuracy of ultrasound in the diagnosis of pneumonia was high.when associated with clinical symptoms of patients,It can be used for patients in the condition of initial assessment.2 The CL score was obviously better than CPIS score for the accuracy of diagnosis of pneumonia.When associated with PCT,the accuracy was highest.