探讨PSI、APACHEⅡ和SOFA评分对医院获得性肺炎患者预后的判断价值以及年龄对SOFA评分效能的影响。

回顾性分析我院2016年1月至2017年12月收治的80例医院获得性肺炎患者的资料，其中未手术组医院获得性肺炎患者40例，围手术组医院获得性肺炎患者40例，用诊断为医院获得性肺炎的24 h内各项实验检查结果和生理参数最差值分别进行PSI、APACHEⅡ和SOFA评分。以30 d后是否存活作为预后指标，绘制受试者工作特征曲线(receiver operating characteristic curve, ROC)，比较三种评分的差别。对SOFA评分在借鉴APACHⅡ年龄评分的基础上再次评分，比较SOFA评分在加权年龄前后评分效能的变化。

ROC曲线分析表明，三种评分均可预测医院获得性肺炎30 d病死率。40例未手术组医院获得性肺炎PSI、APACHEⅡ、SOFA曲线下面积分别为0.75、0.69、0.66。40例围手术组医院获得性肺炎PSI、APACHEⅡ、SOFA曲线下面积分别为0.87、0.64、0.70。80例医院获得性肺炎PSI、APACHEⅡ、SOFA曲线下面积分别为0.80、0.73、0.66。对SOFA评分进行年龄加权后，其40例未手术组医院获得性肺炎曲线下面积为0.75；40例围手术组医院获得性肺炎曲线下面积为0.75；80例医院获得性肺炎曲线下面积为0.72。

PSI评分能较好的评价医院获得性肺炎患者的预后，年龄对医院获得性肺炎的预后评价不容忽视。

To investigate the prognostic value of PSI, APACHEⅡ and SOFA scores in patients with hospital-acquired pneumonia and the effect of age on the efficacy of SOFA score.

The data of 80 patients with hospital-acquired pneumonia admitted in our hospital from January 2016 to December 2017 were retrospectively analyzed. Among them, 40 had non-perioperative hospital-acquired pneumonia and 40 had perioperative hospital-acquired pneumonia. Each group was evaluated by the PSI, APACHEⅡand SOFA scores with the worst physiological parameters within 24 hours after confirmed diagnosis of hospital-acquired pneumonia. Using the survival rate after 30 days as a prognostic index, the operating characteristic curves (ROCs) of the receivers were drawn to compare the difference of the three scores. On the basis of APACHEⅡ age scores, SOFA scores were re-graded to compare the effect of SOFA scores before and after age-weighting.

ROC analysis showed that the three scores could predict the 30-day mortality of hospital-acquired pneumonia. For the 40 cases of non-perioperative hospital-acquired pneumonia, the areas under the curve (AUCs) of ROC in PSI, APACHEⅡ and SOFA were 0.75, 0.69 and 0.66, respectively. And for the 40 cases of perioperative hospital-acquired pneumonia, the AUCs in PSI, APACHEⅡ and SOFA were 0.87, 0.64 and 0.70, respectively. And for the 80 cases of hospital-acquired pneumonia, the AUCs in PSI, APACHEⅡ and SOFA were 0.80, 0.73 and 0.66, respectively. After age-weighting of the SOFA scores, the AUC of the 40 cases of non-perioperative hospital-acquired pneumonia was 0.75, the AUC of the 40 cases of perioperative hospital-acquired pneumonia was 0.75, and the AUC of the 80 cases of hospital-acquired pneumonia was 0.72.

The efficacy of PSI is better than that of APACHEⅡ and SOFA regardless of whether the patient is in surgery, and the efficacy of SOFA score is increased after age-weighting.