| Objective: To Study the predictive valve of confusion,uremia,respiratory,Blood pressure,age 65 years or more(CURB-65)score,procalcitonin(PCT)and quick Sequential Organ Failure Assessment(qSoFA)score in short-term death risk in elderly patients with severe community acquired pneumonia(SCAP),which is convenient to provide provides a reference value for prognostic evaluation of elderly patients with SCAP.Methods: By retrospective analysis,191 elderly patients with SCAP admitted to the Department of Respiratory Medicine of Xianyang Hospital of Yan ’an University from March 2020 to March 2022 were selected as the research objects,tracked 30 days after the onset of disease according to the inclusion criteria,and were divided into survival group(123 cases)and death group(68 cases)according to their survival outcome.The differences of CURB-65 score,PCT,qSoFA score,gender,age,vital signs,combined underlying diseases,other laboratory test indicators and other general information were observed between the two groups,and the in-hospital 30 d mortality among different PCT levels and risk levels of CURB-65 and qSoFA score were compared.The risk factors for predicting short-term death in elderly patients with SCAP were explored,and the predictive value CURB-65 score,qSoFA score,and PCT alone and combined with CURB-65 score on short-term death risk in elderly patients with SCAP was analyzed.Results:(1)There were statistically significant differences in age,respiratory rate,altered state of consciousness,CRP,NLR,PLR,Pa O2,D-D,urea nitrogen,creatinine,CURB-65 score combined with PCT and qSoFA score between the death and survival groups(P < 0.05).The CURB-65,qSoFA score and PCT levels in the death group were higher than those in the survival group(P < 0.05).(2)The in-hospital 30 d mortality of elderly SCAP patients with CURB-65 score and q SOFA score was 8.97% and 4.35% when the risk was low,41.30% and 41.94% when the risk was medium,and 62.69% and 65.00% when the risk was high.The mortality rates were 8.00%,27.78%,42.05% and 58.33% when the PCT levels were ≤0.25μg/L,0.25-0.50μg/L,0.50-2.00μg/L and ≥2.00μg/L.It was found that there were statistical differences in in-hospital 30 d mortality among elderly SCAP patients with different PCT levels and CURB-65 and qSoFA score risk stratification(P < 0.05).(3)Multivariate analysis showed that altered conscious state,CURB-65 score,qSoFA score and PCT level may be independent risk factors for 30 days of hospital death in elderly patients with SCAP(P < 0.05).(4)CURB-65 score,qSoFA score and PCT alone predicted the AUC value of 30 days of hospital death in elderly patients with SCAP(P < 0.05).Among them,the AUC value predicted by PCT was higher than CURB-65 score(Z=2.934,P < 0.05).There was no statistical difference in the predicted AUC values between PCT,qSoFA score and CURB-65 score,qSoFA score(P > 0.05).Compared with CURB-65 single test,the AUC values of CURB-65+PCT,CURB-65+qSoFA and CURB-65+PCT+qSoFA combined test were all higher(P < 0.05).The AUC value of triple detection was better than that predicted by CURB-65+PCT and CURB-65+qSoFA(P < 0.05).The AUC values of CURB-65+PCT and CURB-65+qSoFA showed no statistical difference(P > 0.05).Conclusions:1.CURB-65 score,qSoFA score,and PCT were independent risk factors for death in elderly patients with SCAP,and mortality increased with the increase of PCT and risk stratification of the two scores.2.CURB-65+PCT+qSoFA is more beneficial to predict the short-term death risk of elderly patients with SCAP. |
