| Objectives The purpose of this study was to evaluate the prognostic value of PSI combined with neutrophil to lymphocyte ratio(NLR)and prealbumin(PA)in CAP.Methods According to the inclusion and exclusion criteria,400 adult community-acquired pneumonia(CAP)patients who were hospitalized in the Department of respiratory medicine and critical medicine in the Affiliated Hospital of North China University of science and technology from September 2017 to October 2018 were selected.Death was taken as the prognosis index,including 42 in the death group and 358 in the survival group.The relationship between the prognosis of cap and the scores of PSI,NLR,PA was analyzed by single factor and multi factor Logistic regression.ROC curve was used to screen the prognostic threshold of CAP,and sensitivity,specificity,kappa value were used to evaluate the authenticity and reliability of PSI score,NLR,PA and combined test.Results 1 There were significant differences between the death group and the survival group in the median age,the proportion of hypotension,the proportion of multi lobed infiltration,the level of leukocyte,D-dimer,procalcitonin and the proportion of respiratory failure(P<0.05).There was no significant difference between the two groups in gender,smoking,hypertension,diabetes,hypoproteinemia,chronic obstructive pulmonary disease,temperature?37.3?,pulse?125 times/min,respiratory frequency?30 times/min,pleural effusion,pulmonary nodule,urea nitrogen,fibrinogen and high-sensitivity C-reactive protein(P>0.05).2(1)The PSI score and NLR of patients in the death group were significantly higher than those in the survival group,and the PA level was significantly lower than that in the survival group(P<0.05).(2)The results showed that leukocyte,D-dimer,respiratory failure,PSI score,NLR,PA were closely related to the risk of death in CAP patients(P<0.05).PSI,NLR and PA are independent risk factors for the prognosis of CAP patients.3 The results of ROC curve showed that the area under the curve of PSI score,NLR and PA predicting the death of CAP patients was more than 50%(P<0.05).According to the maximum value of yoden index combined with clinical needs to improve sensitivity and reduce missed diagnosis,the prediction boundary values of PSI score,NLR and PA were 94.50,4.87 and 102.50mg/L respectively.4 Analysis of the effect of PSI,NLR and PA on predicting the death of CAP: the result of PSI was the highest consistent with the actual result(kappa=0.45)and the sensitivity(88.10%)and specificity(83.50%)were higher than those of NLR and PA.5 The parallel experiment based on PSI score was used.The results showed that the consistency of the predicted results of the joint experiment of PSI score and NLR,the joint experiment of PSI score and PA and the actual results were lower than that of the single use of PSI score.However,the combination of PSI score and NLR had a high sensitivity,which could eliminate the missed diagnosis of the pre-test,but the consistency was low,and there would be some errors in clinical application.Conclusions 1 PSI score,NLR and PA are related to the prognosis of CAP.The prognosis of CAP patients was poor with the increase of PSI and NLR,and the decrease of PA.2 PSI,NLR and PA can predict the prognosis of CAP patients.3 PSI score combined with NLR has high sensitivity,which may predict the prognosis of CAP patients early.Figure 3;Table 14;Reference 183... |
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