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目的 评价CURB-65评分联合炎症因子对社区获得性肺炎(community-acquired pneumonia,CAP)住院患者住院期间死亡的预测价值.方法 回顾性分析2013年1月1日至2013年12月31日在四川大学华西医院住院被诊断为CAP的成年患者,收集其入院CURB-65评分、各种炎症因子水平(WBC、ESR、PCT、CRP、IL-6、ALB)及临床结局(住院期间死亡等)等资料.评价CURB-65评分联合炎症因子与CAP患者住院期间死亡的相关性及预后预测价值,采用Logistic回归方法建立CURB-65评分联合炎症因子预测CAP患者住院期间死亡的联合模型并评价其预后预测价值.结果 共纳入505例患者,其中81例于住院期间死亡,死亡率为16.0％.与存活组相比,死亡组患者年龄更大,CURB-65评分更高,男性、患高血压或心脑血管疾病者、胸部影像学检查显示多肺叶受累者、发展为重症肺炎者、入住ICU或行机械通气者所占的比例都更高,差异均有统计学意义(P＜0.05).Logistic回归分析显示CURB-65评分、ALB和IL-6均是CAP患者住院期间死亡的独立预测因子,且它们预测CAP患者住院期间死亡结局的AUC分别为0.75 [95％CI (0.69,0.81)],0.75 [95％CI (0.69,0.81)]和0.75 [95％CI (0.69,0.80)].对Logistic回归新建组合模型的ROC曲线分析发现,ALB与IL-6联合诊断能够提高CURB-65评分对患者住院期间死亡结局的预测价值.CURB-65+ALB+IL-6诊断模型预测患者住院期间死亡结局的AUC为0.84 [95％CI (0.80,0.87)].将ALB、IL-6分别加入CURB-65评分量表中,生成新的CURB-65A和CURB-65I评分量表,两者预测住院期间死亡的AUC均高于CURB-65评分的AUC,其差异均有统计学意义(P＜0.001).结论 CURB-65评分及炎症因子单独使用时对CAP患者住院期间死亡结局的预测价值有限,而联合ALB、IL-6则可提高CURB-65评分的预后预测价值.“,”Objective To evaluate the prognostic values of CURB-65 score and inflammatory factors in hospitalized patients with community-acquired pneumonia (CAP).Methods A retrospective study was conducted in hospitalized adult CAP patients in West China Hospital between January 1st,and December 31 th,2013.Data of CURB-65 score and serum levels of inflammatory factors (WBC,ESR,PCT,CRP,IL-6 and ALB) on admission and clinical outcomes were collected.The associations between CURB-65 score,inflammatory factors and clinical outcomes were examined.Logistic regression analysis was performed to develop combined models to predict in-hospital death of CAP patients,and ROC analysis was conducted to measure and compare the prognostic values of CURB-65 score,inflammatory factors or combined models.Results A total of 505 hospitalized CAP patients were included.81 patients died during the hospitalization and the in-hospital mortality rate was 16.0％.Possible risk factors of in-hospital death included old age,male sex,hypertension,cardiovascular or cerebrovascular diseases,multi-lobular pneumonic infdtration,high risk scores,ICU admission,mechanical ventilation and severe pneumonia (all P values＜0.05).Logistic regression analysis showed that CURB-65 score,ALB and IL-6 were the independent factors in predicting in-hospital death of CAP patients and the area under curve (AUC) of them while predicting in-hospital death were 0.75 (95％CI 0.69 to 0.81),0.75 (95％CI 0.69 to 0.81) and 0.75 (95％CI 0.69 to 0.80),respectively.ROC analysis found that ALB and IL-6 could improve the AUC of CURB-65 score significantly while predicting the in-hospital death (P＜0.05).When ALB and IL-6 were added to the CURB-65 score simultaneously,the AUC was improved to 0.84 (95％CI 0.80 to 0.87).When IL-6 or ALB was added to the CURB-65 score to form a new scale,the AUC of the new scale was significantly higher than that of the CURB-65 score in predicting inhospital death (P＜0.001).Conclusion The prognostic values of CURB-65 score and inflammatory factors may be not ideal when they are used alone in hospitalized CAP patients.IL-6 and ALB may significantly improve the prognostic value of CURB-65 score in predicting in-hospital death.