Clinical Characteristics Of Adult Community Acquired Pneumonia And Prognostic Value Of PSI,CURB-65,and MEWS Scoring Systems

Objective:To explore the clinical characteristics of adult community-acquired pneumonia（CAP）,and compare the Pneumonia severity index（PSI）score,CURB-65（confusion,urea nitrogen,respiratory rate,blood pressure and age≥65）.The value of years and modified early warning score（MEWS）on the prognostic evaluation of adult CAP patients provides a basis for the prognostic evaluation of adult CAP patients.Methods:A retrospective analysis of adult CAP patients admitted to the Department of Respiratory and Critical Care Medicine,Affiliated Hospital of Southwest Medical University from August 2016 to August 2018.Collect the general information of patients,basic diseases,vital signs,clinical symptoms and signs,relevant auxiliary examination results,whether to be admitted to an intensive care unit（ICU）,and outcomes.Based on the collected data,the PSI score,CURB-65 score,and MEWS score were calculated.Based on the patient’s 28-day prognosis outcome,all cases were divided into two groups,namely the death group and the survival group,and the clinical data between the two groups were compared.All the included cases were divided into low-risk group,medium-risk group,and high-risk group according to their severity.The differences in ICU rate and mortality among the three scoring systems were compared.The receiver operating characteristic curve（ROC）was drawn,the area under the curve（AUC）was calculated,and the value of each scoring system on the prognosis of patients with CAP was evaluated and compared.Pearson correlation analysis was used to correlate the three scoring systems.Results:A total of 307 patients with adult CAP were included,53 in the death group and 254 in the survival group.1.General clinical characteristics（compared with the survival group）:smoking history,average age,and average length of stay in the death group were significantly higher than those in the survival group,and the differences were statistically significant（P<0.05）.In the death group,5patients（7.7%）had no underlying disease,21patients（16.4%）combined one,16 patients（18.6%）combined two,9 patients（39.1%）combined three,and four patients combined Two cases（40.0%）,with the increase in the number of combined underlying diseases,the death group ratio,that is,the mortality rate also increased.44 cases（83.0%）of cough,42 cases（79.2%）of sputum,31 cases of dyspnea（58.5%）,14 cases of fever（26.4%）,18 cases of dry sound（34.0%）,and 2 cases of chest pain（3.8%）were rare,and the differences were not statistically significant（P>0.05）.In the death group,6cases（11.3%）were unconscious,8 cases were vomiting（15.1%）,17 cases were abdominal pain（32.1%）,12 cases were diarrhea（22.6%）,19 cases were nausea（35.8%）,and 47 cases were wet（65.7%）,26 cases of hypotension（49.1%）,the composition ratio of the above symptoms in the death group was higher than that in the survival group,and the differences were statistically significant（P<0.05）.The white blood cell count（12.3±6.111×10⁹/L）,neutrophil percentage（84.02±8.613%）,and PCT（7.45±8.577ng/ml）in the death group were significantly higher than those in the survival group,and the differences were statistically significant（P<0.05）.In the death group,20 patients（37.7%）had serum creatinine>104umol/L,25 patients（47.2%）had BUN≥11mmol/L,34patients（64.2%）had hypoproteinemia,20 patients（37.7%）had electrolyte disturbances,and PaO₂<60mmHg.In 38 cases（71.7%）,PaCO₂>45mmHg in 26 cases（49.1%）,and pleural effusion in 34 cases（64.2%）,the composition ratio of the above auxiliary examination indicators in the death group was higher than that in the survival group,and the differences were statistically significant（P<0.05）.Forty-one patients（77.4%）were admitted to the ICU in the death group,and the ICU composition ratio in the death group was higher than that in the survival group,and the difference was statistically significant（P<0.05）.The PSI score（148.83±30.941）,CURB-65 score（2.57±1.264）,and MEWS score（5.55±2.215）in the death group were higher than those in the survival group,and the differences were statistically significant（P<0.05）.ICU rate and mortality in different strata of each scoring system:ICU rate and mortality in different strata of PSI score are low-risk group:2.9%and2.1%;intermediate-risk group:16.9%and 9%;high-risk Group:80.8%and53.8%;CURB-65 scores in different stratified ICU rates and mortality were low-risk groups:11.8%and 8.6%;intermediate-risk groups:20.8%and 14.3%;high-risk groups:61.5%,37.2%;MEWS scores,ICU rate and mortality in different strata are low-risk group:9.8%,7.5%;intermediate-risk group:65.1%,36%;high-risk group:71.4%,85.7%;different strata,with Significant increase in the score,ICU admission rate,mortality increased significantly,the difference was statistically significant（P<0.05）.The ROC curve shows that the AUC of the ICU stay at the PSI score,the CURB-65 score,and the MEWS score are 0.917,0.788,and 0.852,respectively,and their sensitivity to the prediction of the ICU stay are 76.83%,58.54%,and 74.39%,respectively.They are 95.11%,86.67%,and 85.78%.The ROC curve showed that the AUCs of PSI,CURB-65,and MEWS scores for death prediction were 0.880,0.728,and0.806,and the best cutoffs for PSI,CURB-65,and MEWS scores were 122,2,and 4,respectively.Points,the sensitivity to death prediction was 88.68%,54.72%,and 69.81%,and the specificity was 81.89%,80.71%,and 77.95%,respectively.Conclusion:1.The adult CAP death group had an average age,many Basic diseases and complications,atypical clinical symptoms,and long hospital stays.2.The PSI score,CURB-65,and MEWS scores are all suitable for predicting the risk of ICU admission and death in adult CAP patients.The predictive efficacy of staying in ICU and death is:PSI score is better than MEWS score,MEWS score is better than CURB-65 score,but MEWS score is simpler and easier than PSI score,and it has stronger clinical practicability.