Prognostic Value Of Procalcitonin,CURB-65 And SMART-COP Scores In Community Acquired Pneumonia

ObjectiveTo study the clinical value of procalcitonin,CURB-65 and SMART-COP scores in evaluating the prognosis of patients with community-acquired pneumonia,which is convenient to guide the clinical evaluation of prognosis.MethedsThe case data of 150 CAP patients(according to《the CAP diagnostic criteria in the Guidelines for the Diagnosis and Treatment of Chinese Adult Community-acquired Pneumonia(2016 Edition)》)admitted to the First Department of Respiratory and Critical Care of Shaanxi Provincial People’s Hospital,from November 2019 to November 2020 were collected.According to the outcome of treatment,the patients were divided into survival group and death group.The general conditions,vital signs,complications,laboratory examination,imaging examination and outcome results of the patients were collected.CURB-65 and SMART-COP were scored.The differences of each variable between the survival group and the death group were compared.Receiveroperating characteristic curve(ROC)was used to analyze the specificity and sensitivity of procalcitonin,CURB-65 score,SMART-COP score,procalcitonin combined with CURB-65,procalcitonin combined with SMART-COP score for prognosis prediction of patients.Meanwhile,the Area Under curve(AUC)was calculated and the AUC of the four groups was compared.These results were compared with procalcitonin,CURB-65,and SMART-COP score to assess the effectiveness of prognosis of community-acquired pneumonia.Statistical software SPSS25.0 was used to analyze the data above.Results1.According to the inclusion and exclusion criteria of subjects,21 cases were excluded and 129 cases were finally included.There were 109 patients in the survival group and 20 patients in the death group,including 77 male patients 52 female patients.Among them,58 cases were younger than 65 years old and 71 cases were older than 65 years old.There was no statistical difference in gender composition between the survival group and the death group,and the results were not statistically significant(P=0.975).There was a statistically significant difference in age between the survival group and the death group(P=0.001).Results showed that the number of patients with age < 65 years of age had fewer cases than those with age ≥65 years of age(58 VS 71),and the mortality rate of those with age ≥65years of age was higher than that of those with age<65 years of age(26.8% VS 1.7%,P=0.001).2.The co-incidence of coronary heart disease between the two groups was different(P< 0.05).There was no significant difference in patients with type 2 diabetes mellitus,cerebrovascular disease,hypertension,Chronic obstructive pulmonary disease,digestive system disease and kidney disease,and the results showed no statistical significance(all P >0.05).There were significant differences between the two groups in conscious state,mechanical ventilation,Acute kidney injury(AKI),chest radiograph with multiple lobes and segmental infiltration,respiratory rate,heart rate,p H,Pa O2,BUN and PCT(P <0.05).There were no significant differences in body temperature,systolic blood pressure and diastolic blood pressure between the two groups(P>0.05).There were significant differences in respiratory rate and heart rate between the two groups(P>0.05).3.The mean CURB-65 scores in survival and death groups were [1(0,2)VS 3(2.25,4)],P<0.001,showing a statistically significant difference between the two groups.Mean SMART-COP scores in the survival and death groups were [2(1-3.5)VS 6(5-7)],P<0.001.The mean scores of CURB-65 and SMART-COP in the death group were higher than those in the survival group.There was a statistical difference between the two groups.4.Bariate Logistic regression analysis showed that PCT,CURB-65 score,SMART-COP score,PCT,conscious state,BUN,respiration,age,and ALB were independent risk factors for prognostic death.5.The ROC curve results showed that the area under the ROC curve of PCT was 0.894,the sensitivity was 80%,and the specificity was 88.1%.CURB-65 was 0.914 under the ROC curve,with a sensitivity of 75% and specificity of 91.7%.The area under the ROC curve of SMART-COP score was 0.955,the sensitivity was 85%,and the specificity was96.3%.The area under the ROC curve of PCT+CURB-65 was 0.931,with a sensitivity of75% and specificity of 94.5%.The area under the curve of PCT+ SMART-COP ROC was0.966,the sensitivity was 95%,and the specificity was 88.1%.The area under the curve of PCT,CURB-65 and SMART-COP was 0.964 sensitivity 90% and specificity 94.5%.The area difference under the curve was statistically significant(P<0.001).Conclusion1.PCT,CURB-65 and SMART-COP all predicted the prognosis of patients with CAP.2.PCT+CURB-65+CURB-COP had the highest prognostic accuracy,followed by PCT+CURB-65+CURB-COP,and the combination of PCT+CURB-65+CURB-COP could not improve the assessment value.Overall,the combined assessment value was better than that of the single assessment.PCT+CURB-65+CURB-COP had the highest prognostic sensitivity.The specificity of SMART-COP was the highest,followed by PCT+CURB65and PCT+ CURCUR-65+SMART-COP.3.The sensitivity of PCT+SMART-COP was the highest,followed by PCT + CURB-65+ SMART-COP.The specificity of SMART-COP was the highest,followed by PCT +CURB-65 and PCT + CURB-65 + SMART-COP.