The Value Of QSOFA Score And NLCR In Predicting The Severity Of Adult Community Acquired Pneumonia

Background: Community-acquired pneumonia(CAP)is a common and frequently-occurring disease,seriously harms human health.In the past few decades,despite great advances in medicine and the development of antibiotics,the mortality rate in CAP has remained high.CAP,especially severe CAP,can develop into sepsis with severe systemic poisoning symptoms,which can easily lead to serious complications.The disease develops rapidly,which may endanger the life of patients if not timely treated.Early identification of high-risk patients to be positive and effective anti-infection treatment is very important to improve the prognosis of disease.Current clinical guidelines recommend pneumonia-specific scoring systems such as CURB-65 score and PSI to evaluate the severity of pneumonia,but practice has proved that these scoring systems have some limitations.The quick sequential organ failure(qSOFA)score proposed in the esis3.0 standard has been proved to be useful in predicting the severity of pneumonia,and studies have shown that infectious biomarkers such as c-reactive protein and calcitonin can assist clinicians in formulating pneumonia diagnosis and treatment plans.The neutrophilic lymphocyte ratio(NLCR),a biomarker of infectious agents,has been shown to be useful in the diagnosis of bacteremia,and its value in predicting pneumonia severity and prognosis is unclear.Therefore,this study aims to explore the application value of qSOFA score and NLCR in the stratification of pneumonia risk,and to provide new diagnosis and treatment ideas for the clinical diagnosis and treatment of pneumonia.Obiective: To explore the value of rapid sequential organ failure assessment(qSOFA)score,neutrophil-lymphocyte ratio(NLCR),and their combination in predicting severity of disease,mortality within 28 days of admission,and risk of ICU admission in adult community-acquired pneumonia(CAP)patients.Methods: A total of 299 inpatients diagnosed as CAP were selected from the second affiliated hospital of anhui medical university from December 2014 to February 2019.The patients were divided into severe community-acquired pneumonia(SCAP)group and non-severe community-acquired pneumonia(NSCAP)group,death group and survival group,and ICU group and non-icu group according to their severity of illness,whether they died within 28 days of admission and whether they were admitted to ICU.The differences of qSOFA score and NLCR value between groups were compared.The predictive value of qSOFA score,NLCR,and a combination of the two for severe pneumonia,mortality within 28 days,and ICU admission in CAP patients was analyzed by drawing a receiver operating characteristic(ROC)curve.Results: The qSOFA score and NLCR value of the severe CAP group were higher than that of the non-severe CAP group,the death group was higher than that of the survival group,and the ICU group was higher than that of the non-severe CAP group(P < 0.05).The AUC values of severe CAP predicted by qSOFA score,NLCR and qSOFA score combined with NLCR were 0.92,0.83 and 0.85,respectively.Predict the AUC value of death were 0.89,0.78 and 0.79;Prediction of ICU admission AUC value was 0.86,0.78 and 0.79,respectively.The AUC values of the qSOFA score predicting the severity of CAP and mortality were higher than the AUC values of the NLCR and the combination of the two(P < 0.05),and there were no significant differences between qSOFA score,NLCR and combination of the two in predicting ICU admission(P > 0.05).The sensitivity of the qSOFA score,the NLCR and the two combined to predict severe pneumonia was 54.3%,69.5% and 83.7%,respectively.The specificity was 99.0%,87.4% and 86.5%,respectively.The sensitivity to predict death was 60.4%,66.0% and83.0%,respectively.The specificity was 92.8%,77.6% and 75.2%,respectively.The sensitivity and specificity of perdicting ICU admission were 54.2%,67.7%,81.4%,respectively,and 91.6%,79.2%,76.2%,respectively.Conclusions: Both qSOFA scores and NLCR can be used to predict the severity of CAP,the qSOFA scores has higher specificities,but its sensitivities are lower,combining it with NLCR can improve the sensitivities of prediction.