内科

目的探讨慢性呼吸系统早期预警评分（CREWS）预测急性加重期慢性阻塞性肺疾病（COPD）机械通气患者院内死亡的价值。方法对2017年3月至2018年3月我院收治的96例急性加重期COPD患者的临床资料进行回顾性分析，根据院内死亡情况将患者分为死亡组及存活组。比较两组患者的性别、年龄、病程、肺功能分级、CREWS评分等情况；对急性加重期COPD机械通气患者院内死亡的危险因素进行多因素Logistic回归分析；通过绘制ROC曲线，分析CREWS评分预测急性加重期COPD机械通气患者院内死亡的价值。结果单因素分析结果显示，死亡组患者的CREWS评分显著高于存活组（P＜0.05），两组患者的性别、年龄、肺功能分级、病程比较差异无统计学意义（P＞0.05）。多因素Logistic回归分析结果显示，CREWS评分是急性加重期COPD机械通气患者院内死亡的危险因素。CREWS评分预测急性加重期COPD机械通气患者院内死亡的ROC曲线下面积为0.826，95%CI为0.745～0.908，最佳截断点为CREWS评分≥5分；根据CREWS评分预测患者院内死亡的敏感度为56.80%，特异性为98.10%。结论根据CREWS评分预测急性加重期COPD机械通气患者的院内死亡的敏感度较低，而特异性较高，患者院内死亡的风险随CREWS评分的增高而增大，需高度重视。

ObjectiveTo investigate the value of Chronic Respiratory Early Warning Score (CREWS) predicting death in the hospital on acute exacerbation of chronic obstructive pulmonary disease (COPD) treated with mechanical ventilation. MethodsRetrospective analysis was performed on the clinical data of 96 patients with acute exacerbation of COPD admitted to our hospital from March 2017 to March 2018. Patients were divided into death group and survival group according to the death in the hospital. The situation of gender, age, course of disease, classification of pulmonary function, and CREWS score etc. were compared between the two groups. Multivariate logistic regression analysis was performed on risk factors for the death in the hospital in patients with acute exacerbation of COPD treated with mechanical ventilation. Value of CREWS predicting death in the hospital on acute exacerbation of COPD treated with mechanical ventilation was analyzed according to the ROC curve drawing. ResultsUnivariate analysis exhibited that the CREWS score of the death group was significantly higher than that of the survival group (P＜0.05). There were no statistically significant differences in gender, age, classification of pulmonary function, and course of disease between the two groups (P＞0.05). Multivariate logistic regression analysis revealed that the CREWS score was the risk factor for death in the hospital in patients with acute exacerbation of COPD treated with mechanical ventilation. The CREWS score predicted that the area under the ROC curve for death in the hospital on acute exacerbation of COPD treated with mechanical ventilation was 0.826, 95% of CI was 0.745 to 0.908, and the best truncation point was CREWS score ≥5 points. The sensitivity and specificity of CREWS score for predicting hospital death were 56.80% and 98.10%, respectively. ConclusionThe sensitivity of death in the hospital on acute exacerbation of COPD treated with mechanical ventilation is lower according to the prediction based on CREWS score, whereas the specificity is higher. The risk of death in the hospital increases when the CREWS score increases, and thus a great concern should be paid to this situation.