Evaluation Value Of APACHE ? Score And SCS Combined With The Oxygenation Index On The Prognosis Of The Severe Community-acquired Pneumonia Of The Elderly Patients

Objective:The clinical value of APACHE II score,SCS score,oxygenation index,SCS score and combined oxygenation index in the prognosis evaluation of elderly patients with severe community acquired pneumonia was compared by statistical analysis of the clinical data of hospitalized elderly patients with severe community acquired pneumonia and related clinical data within 24 hours of admission.Methods:This study used a retrospective analysis method to analyze the elderly patients with severe community acquired pneumonia admitted to the Department of Respiratory and Critical Care Medicine,ICU and Emergency Department of the First Hospital of Jilin University from January 2015 to November 2018.A total of100 patients were included in this study,including 61 males and 39 females,aged from 65 to 97.All patients met the following inclusion criteria(1,?65 years old group;2,the diagnostic criteria of SCAP formulated by Respiratory Disease Society of Chinese MedicalAssociation in 2016;3,complete and reliable clinical data)and exclusion criteria(1,age < 65 years old;2,patients with severe immunosuppression,such as hematopathy,AIDS,bone marrow transplantation;3,patients with granulocytopenia or undergoing radiotherapy and chemotherapy;4,Patients with incomplete clinical data;5,Patients with unstable vital signs may be caused by other disease factors besides pneumonia).Detailed records of all patients' hospitalization data,including gender,age,personal history,underlying diseases,glucocorticoid using before hospitalization,mechanical ventilation,diagnosis and treatment results,antibiotic use(type,combination of drugs and medication time),and clinical data of APACHE II score,SCS score and oxygenation index within24 hours of admission for each patient were collected.If there were duplicate data,select the worst value within 24 hours.APACHE II score was calculated by Knaus method and SCS score was calculated by simple clinical scale.Arterial blood samples were detected by ABL80 blood gas analyzer(Danish Reddo Company),and oxygenation index was calculated.Finally,SPSS 18.0 statistical software was used for statistical analysis to evaluate the prognostic effect of APACHE II score,SCS score,oxygenation index,SCS score and combined oxygenation index on elderly patients with severe community acquired pneumonia.Results:(1)The 100 elderly patients with severe community acquired pneumonia included in this study were mainly distributed in emergency medicine,ICU and respiratory medicine,accounting for87% of the total number of patients.The proportion of patients in the three departments was 41%,31% and 15% of the total number,respectively.(2)Of the 100 patients included,70 died,30 were cured,and the mortality rate was 70%.(3)The days of hospitalization and antimicrobial use in the elderly patients with severe community acquired pneumonia were shorter than those in the survival group,the types of antibiotics and the proportion of mechanical ventilation were higher than those in the survival group,the oxygenation index was lower than that in the survival group,the APACHE II score and SCS score were higher than those in the survival group,and the differences between the two groups were statistically significant(P < 0.05).There were no significant differences in sex,smoking history,history of glucocorticoid or immunosuppressive agent use and age between the two groups(P > 0.05).(4)The mortality of elderly patients with severe community acquired pneumonia was positively correlated with APACHE IIscore and SCS score(?4 points),and negatively correlated with oxygenation index.(5)The AUC of oxygenation index was 0.689(95% CI:0.577-0.796),sensitivity was 0.500,specificity was 0.814,There are statistical significance between the two groups(P < 0.05);The AUC of APACHE II score was 0.749(95% CI: 0.641-0.857),sensitivity was 0.743,specificity was 0.700.There are statistical significance between the two groups(P < 0.05).The AUC of SCS score was0.623(95% CI: 0.506-0.740),the sensitivity was 0.529,and the specificity was 0.733.There was no significant difference between the two groups(P > 0.05).SCS score combined with oxygenation index,AUC was 0.723(95% CI: 0.615-0.832),sensitivity was 0.586,specificity was 0.867,There was statistical significance between the two groups(P < 0.05).Conclusions:(1)The death group of elderly patients with severe community acquired pneumonia was shorter than the survival group in terms of hospitalization days and days of antibiotic use,types of antibiotics,proportion of mechanical ventilation,APACHE II score and SCS score,while the oxygenation index was lower.(2)The mortality of elderly patients with severe community acquired pneumonia increased with the increase of APACHE IIscore and SCS score(? 4 points),and increased with the decrease of oxygenation index,and was negatively correlated.(3)The prognostic evaluation value of elderly patients with severe community acquired pneumonia is APACHE II score,SCS score combined with oxygenation index,oxygenation index and SCS score.SCS combined with oxygenation index has higher accuracy but lower sensitivity.