Predictive Value Of Three Different Scoring Systems For Assessing Severity Of Severe Community-acquired Pneumonia Patients

Background Severe community acquired pneumonia(SCAP)is an infectious disease of the respiratory system.It is critically ill with a high fatality rate.Therefore,the early identification of high-risk patients,active and effective anti-infective therapy are crucial for the prognosis of the disease.Severity grading and clinical prognostic evaluation of SCAP have always been the focus of research and the difficulty of clinical work.Clinically,we can find that severe pneumonia can lead to sepsis,and sepsis is the most common cause of respiratory failure.They interact with each other.The 2016 International Consensus Conference on Systemic Infection,redefined sepsis as a clinical syndrome of lethal organ dysfunction caused by infection and proposed the concept of qSOFA.With widespread acceptance of the new definition of sepsis,researchers have found that the qSOFA score not only predicts the prognosis of sepsis but can also be used to predict the severity of the disease in patients with SCAP.This article aims to investigate whether the new qSOFA scoring system can be used to assess the severity of SCAP and to compare it with the traditional pneumonia scoring tools CURB-65 and CRB-65.Objective To study the value of there different scoring systems,such as the quick Sepsis-related Organ Failure Assessment(qSOFA),the 6-point CURB-65 scale adopted by the British Thoracic Society and the simpler CRB-65 for assessing 28 day mortality and ICU admission in severe community-acquired pneumonia(SCAP)patients.Methods The 164 patients with SCAP hospitalized into emergency department and respiratory from January 2011 to March 2017 were collected retrospectively and analyzed.The qSOFA,CURB-65 and CRB-65 scores and Clinical characteristics were collected upon hospitalization,including gender,age,complications(hypertension,diabetes,COPD,cerebrovascular disease,coronary heart disease,malignancy,kidney function dysfunction).The basic vital signs(temperature,pulse,breathing rate,blood pressure)were recorded during hospital stay.Compare the difference of the 28 day mortality and ICU admission in each risk score of the different scoring systems.According to prognosis of 28 days and the ICU admission for the end of observation,drawing the receiver-operating characteristic(ROC)curves of the three scores and comparing their area under the curve(AUC)to determine the predictive value of severity.Results 164 patients were enrolled in this study and the overall mortality and intensive care unit(ICU)admission rates were 36.6% and 19.5%,respectively.The qSOFA,CURB-65 and CRB-65 scores of the survival group were lower than the death group(P?0.05).All three predictive rules showed the same trend of increasing mortality with the higher scores(P?0.05).For predicting 28 day mortality,the qSOFA,CURB-65 and CRB-65 performed similarly,and the areas under the receiver operating characteristic(ROC)curve were 0.735(95% CI 0.627 to 0.843),0.763(95% CI 0.662 to 0.865)and 0.737(95% CI 0.626 to 0.848),respectively.For predicting ICU admission,the qSOFA,CURB-65 and CRB-65 performed similarly,and the areas under the receiver operating characteristic(ROC)curve were 0.68(95% CI 0.54 to 0.81),0.67(95% CI 0.54 to 0.81)and 0.69(95% CI 0.56 to 0.83),respectively.Conclusion The new scoring system qSOFA can be used to predict the severity of SCAP disease.The qSOFA score,CURB-65 score and CRB-65 score have a similar performance in predicting the severity of SCAP patients.And the qSOFA score can be widely used in clinical practice as the advantage of quick evaluating.