Evaluation of Pneumonia Severity and Acute Physiology Scores to Predict ICU Admission and Mortality in Patients Hospitalized for Influenza 英文参考文献.docVIP

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Evaluation of Pneumonia Severity and Acute Physiology Scores to Predict ICU Admission and Mortality in Patients Hospitalized for Influenza 英文参考文献.doc

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Evaluation of Pneumonia Severity and Acute Physiology Scores to Predict ICU Admission and Mortality in Patients Hospitalized for Influenza 英文参考文献

EvaluationofPneumoniaSeverityandAcutePhysiology ScorestoPredictICUAdmissionandMortalityinPatients HospitalizedforInfluenza MatthewP.Muller1*,AllisonJ.McGeer2,KaziHassan3,JohnMarshall4,MichaelChristian5,6*,forthe TorontoInvasiveBacterialDiseaseNetwork 1DepartmentofMedicine,St.Michael’sHospital,UniversityofToronto,Toronto,Canada,2DepartmentofLaboratoryMedicineandPathobiology,MountSinaiHospital, University ofToronto, Toronto, Canada, 3Mount Sinai Hospital,University of Toronto, Toronto, Canada, 4Department ofSurgery,St.Michael’sHospital,University of Toronto,Toronto,Canada,5DepartmentofMedicine,MountSinaiHospitalandUniversityHealthNetwork,UniversityofToronto,Toronto,Canada,6CanadianForces HealthServices,Toronto,Canada Abstract Background: The demand for inpatient medical services increases during influenza season. A scoring system capable of identifyinginfluenzapatientsatlowriskdeathorICUadmissioncouldhelpcliniciansmakehospitaladmissiondecisions. Methods:Hospitalizedpatientswithlaboratoryconfirmedinfluenzawereidentifiedover3influenzaseasonsat25Ontario hospitals. Each patient was assigned a score for 6 pneumonia severity and 2 sepsis scores using the first data available following their registration in the emergency room. In-hospital mortality and ICU admission were the outcomes. Score performancewasassessedusingtheareaunderthereceiveroperatingcharacteristiccurve(AUC)andthesensitivityand specificityforidentifyinglowriskpatients(riskofoutcome,5%). Results:Thecohortconsistedof607adultpatients.Meanagewas76years,12%ofpatientsdied(71/607)and9%required ICU care (55/607). None of the scores examined demonstrated good discriminatory ability (AUC$0.80). The Pneumonia SeverityIndex(AUC0.78,95%CI0.72–0.83)andtheMortalityinEmergencyDepartmentSepsisscore(AUC0.77,95%0.71– 0.83) demonstrated fair predictive ability (AUC$0.70) for in-hospital mortality. The best predictor of ICU admission was SMART-COP(AUC0.73,95%CI0.67–0.79).Allotherscoreswerepoorpredictors(AUC,0.70)ofeitheroutcome.If