Abstract:Objective: To investigate the microbiological characteristics and the predictive value of Clinical Pulmonary Infection Score (CPIS) and Sequential Organ Failure Score (SOFA) in patients with chronic obstructive pulmonary disease (COPD) complicated by ventilator-associated pneumonia (VAP). Methods: A total of 136 COPD patients admitted to our hospital from November 2019 to November 2021 were selected and divided into study group (n=60) and reference group (n=76) according to whether the patients had VAP or not, and 50 healthy subjects during the same period were selected as the control group. The baseline characteristics and CPIS and SOFA scores of the three groups of patients with different prognosis were compared, and the multi-factors associated with VAP-related pathogen resistance, COPD combined with VAP and poor prognosis were analyzed; the predictive value of CPIS, SOFA and combined scores on the prognosis of COPD combined with VAP was analyzed. Results: Diabetes, pulmonary tuberculosis, multiple hospitalizations due to COPD, and antibiotic use within 3 months in the study group were higher than those in the reference group, and the CPIS and SOFA scores were higher than those in the reference group, which were risk factors for COPD complicated with VAP (P<0.05); the resistance rate of Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii to imipenem and imipenem was less than 10%, and the drug resistance rate was low; the CPIS and SOFA scores in the poor prognosis group were significantly higher than those in the good prognosis group (P<0.05); CPIS and SOFA scores were risk factors for poor prognosis of COPD combined with VAP (P<0.05); the AUC of CPIS combined with SOFA score in predicting the prognosis of COPD combined with VAP was higher than that of CPIS and SOFA score (P<0.05). Conclusion: Elevated CPIS and SOFA scores are risk factors and prognostic risk factors for COPD complicated with VAP. VAP antimicrobial therapy should be administered according to the drug sensitivity results, and combined evaluation is beneficial to the prognosis of patients.
李世亮, 马冬梅, 相晓波. COPD合并VAP患者的微生物学特征及CPIS SOFA评分的预测价值[J]. 河北医学, 2023, 29(1): 141-147.
LI Shiliang, MA Dongmei XIANG Xiaobo. Microbiological cCharacteristics and pPredictive vValue of CPIS and SOFA sScores in COPD pPatients with VAP. HeBei Med, 2023, 29(1): 141-147.
[1] 何玉琢,徐伟,王海波,等 安徽省40岁及以上人群慢性呼吸道症状流行及慢性阻塞性肺疾病认知现状[J].中国慢性病预防与控制,2021,29(3):172-177. [2] 焦文妤,高爱华.血清可溶性髓系细胞触发受体-1与临床肺部感染评分在慢性阻塞性肺疾病呼吸机相关性肺炎早期诊断及预后判断中的效能研究[J].陕西医学杂志,2020,49(12):1630-1633,1637. [3] 王妮娜,陈洋,高宏彪,等.不同声门下单次冲洗时间对气管切开术后机械通气患者临床效果及28d病死率影响的对比研究[J].实用心脑肺血管病杂志,2021,29(2):108-111. [4] 郑娜敏,顾乐,吕建农.PSI评分对呼吸机相关性肺炎患者预后价值的评估[J].中国急救复苏与灾害医学杂志,2019,14(4):323-327. [5] 刘丽华,蒋春亭.慢性阻塞性肺部疾病[M].合肥:安徽科学技术出版社,1985.36-39. [6] 中华医学会重症医学分会.呼吸机相关性肺炎诊断,预防和治疗指南(2013)[J].中华内科杂志,2013,52(6):524-543. [7] 尚红,王毓三,申子瑜.全国临床检验操作规程[M].北京:人民卫生出版社,2015.78-83. [8] 罗源,许继梅,王继灵.肺部超声联合CRP,PCT,sTREM-1检测及CPIS评分在呼吸机相关性肺炎早期诊断中的价值[J].分子诊断与治疗杂志,2022,14(1):58-56. [9] Humphries R M, Ambler J, Mitchell S L,et al.CLSI methods development and standardization working group best practices for evaluation of antimicrobial susceptibility tests[J].Clin Microbiol,2018,56(4):1934-1951. [10] 杨海龙,赵丽英,孟波,等.2型糖尿病对ICU机械通气患者呼吸机相关性肺炎的影响[J].临床肺科杂志,2019,24(1):33-36. [11] 李燕平,张峡嶶,江秀慧,等.肺结核并发呼吸机相关性肺炎的危险因素和预防措施[J].中国卫生工程学,2020,19(5):704-706. [12] Tsakiridou E, Mega A M, Zakynthinos E,et al.title:pre-intensive care unit intubation and subsequent delayed intensive care unit admission is independently associated with increased occurrence of ventilator-associated pneumonia short title:role of delayed icu admission after intubation[J].Clin Respir,2018,12(10):2497-2504. [13] 吕培瑾.慢性阻塞性肺疾病加重患者呼吸机相关性肺炎的预测指标和微生物学特征[J].安徽医药,2022,26(4):770-773. [14] 谢柏梅,敬梅,路晓艳,等.CPIS评分及血清PCT在慢性阻塞性肺疾病呼吸机相关性肺炎诊断和预后判断中的应用价值[J].临床和实验医学杂志,2018,17(15):1617-1620. [15] 张春玲,杨远见,刘畅,等.血清降钙素原,肝素结合蛋白,白细胞介素6联合序贯器官衰竭评分对重症肺炎患者预后评估的意义[J].实用医学杂志,2022,38(2):,168-172. [16] 郑娜敏,顾乐,吕建农.PSI评分对呼吸机相关性肺炎患者预后价值的评估[J].中国急救复苏与灾害医学杂志,2019,14(4):323-327.