Objective To evaluate the predictive value of CURB-65 score combined with blood urea nitrogen to albumin ratio (B/A) for intensive care unit (ICU) admission and death in adults with community-acquired pneumonia (CAP). Methods A retrospective analysis was performed on 523 patients with CAP hospitalized in the Second Affiliated Hospital of Kunming Medical University from January 2018 to January 2022. According to whether the patients were admitted to ICU, they were divided into an ICU group (n=36) and a general ward group (n=487). The patients were divided into a death group (n=45) and a non-death group (n=478) according to the death situation during hospitalization. Basic data (age, gender, history of underlying diseases, etc.), hospital stay, antibiotic use days, CURB-65 score, white blood cell count (WBC), neutrophil count (NEUT), procalcitonin (PCT), C-reactive protein (CRP), serum albumin (Alb), blood urea nitrogen (BUN), and BUN to Alb ratio (B/A) of the two groups were compared respectively. Receiver operating characteristic (ROC) curve were plotted to evaluate the predictive value of CURB-65 score, B/A, and their combination for death during ICU admission and hospitalization in patients with CAP. Logistic regression was used to analyze risk factors for in-hospital death in the patients with CAP. Results The number of days in hospital, the number of days of antibiotic use, the number of deaths during hospitalization, the proportion of hypertension, diabetes, CURB-65 score, WBC, NEUT, PCT, CRP, BUN and B/A in the ICU group were significantly higher than those in the general ward group. Age, male, combined hypertension, diabetes, coronary heart disease, ICU admission, CURB-65 score, WBC, NEUT, PCT, CRP, BUN and B/A in the death group were significantly higher than those in the non-death group, and Alb in the ICU group and the death group were significantly lower (all P<0.05). Correlation analysis showed that B/A was positively correlated with PCT, CRP, WBC, NEUT and CURB-65 scores (correlation coefficient r values were 0.486, 0.291, 0.260, 0.310, 0.666, all P<0.001). The area under ROC curve of CURB-65 combined with B/A to predict ICU admission and death of CAP patients was 0.862 (95%CI 0.807 - 0.918, sensitivity 91.7%, specificity 66.4%) and 0.908 (95%CI 0.864 - 0.952, sensitivity 93.3%, specificity 75.7%), respectively. Multivariate logistic regression analysis showed that diabetes, high CURB-65 score, low Alb level and B/A≥4.755 mg/g were independent risk factors for death of CAP patients during hospitalization (P<0.05). Conclusions There is a significant correlation between elevated B/A and ICU demand and mortality in CAP patients. Combined use can improve the predictive value of CURB-65 score for ICU admission and mortality in CAP patients.
Objective To identify independent risk factors for in-hospital all-cause mortality in patients with sepsis and to integrate them into the quick Sequential Organ Failure Assessment (qSOFA) score to construct modified models, thereby improving the ability of the original qSOFA to predict mortality risk. Methods This retrospective study included adult patients who met the Sepsis-3 criteria for sepsis and were admitted to the Intensive Care Unit or Emergency Intensive Care Unit of Zigong Fourth People’ s Hospital between January 2018 and December 2023. Demographic characteristics, vital signs, comorbidities, and laboratory parameters were collected, and the Sequential Organ Failure Assessment (SOFA) and qSOFA scores were calculated. Multivariable logistic regression analysis was used to identify independent predictors of in-hospital mortality. Independent predictors were dichotomized according to cut-off values derived from receiver operating characteristic (ROC) curves and combined with qSOFA to construct new models. The ROC analysis with bootstrap validation was used to assess predictive performance, and comparative performance was further evaluated using net reclassification improvement (NRI) and integrated discrimination improvement (IDI). Results A total of 218 patients were included. Multivariable logistic regression analysis identified blood urea nitrogen (BUN) [odds ratio (OR)=1.100, 95% confidence interval (CI) (1.040, 1.170)] and qSOFA [OR=2.610, 95%CI (1.450, 4.920)] as independent risk factors for in-hospital mortality, whereas high-density lipoprotein cholesterol (HDL-C) was an independent protective factor [OR=0.250, 95%CI (0.065, 0.841)]. After dichotomization by ROC-derived cut-off values, BUN and HDL-C were incorporated into qSOFA to generate B-qSOFA, H-qSOFA, and BH-qSOFA. Bootstrap ROC analysis showed that BH-qSOFA exhibited the highest discriminatory ability compared with all combined models as well as the conventional SOFA and qSOFA scores [area under the curve=0.803, 95%CI (0.735, 0.863)]. NRI and IDI analyses demonstrated that BH-qSOFA provided incremental prognostic improvement over qSOFA (NRI=0.969, IDI=0.165), B-qSOFA (NRI=0.644, IDI=0.054), and H-qSOFA (NRI=0.804, IDI=0.091) (all P<0.05). Conclusions Elevated BUN and qSOFA and decreased HDL-C are independent predictors of in-hospital mortality in sepsis. The BH-qSOFA model is simple and clinically practical, exhibits superior predictive performance over the original qSOFA. It may serve as a useful early instrument for prognostic risk stratification in patients with sepsis.
Objective Exploring the risk factors for sarcopenia in elderly patients with chronic obstructive pulmonary disease (COPD) and constructing a risk prediction nomogram model. Methods A retrospective study was conducted on elderly COPD patients admitted to the General Internal Medicine Department of Tianjin Hospital in Tianjin from January 2024 to December 2024. They were divided into a sarcopenia group and a non-sarcopenia group based on the presence of sarcopenia. General data of the two groups were compared, and logistic regression analysis was used to identify risk factors for sarcopenia in elderly COPD patients. The diagnostic value of blood urea nitrogen/creatinine (BUN/Cr) in predicting COPD with sarcopenia was evaluated using receiver operating characteristic (ROC) curve analysis. Additionally, a risk prediction nomogram model was constructed and validated. Results The study included a total of 128 patients, with 30 cases in the sarcopenia group and 98 cases in the non-sarcopenia group. The sarcopenia group had higher age, age-adjusted Charlson comorbidity index (ACCI), and BUN/Cr ratio than the non-sarcopenia group (P<0.05); body mass index (BMI), low-density lipoprotein cholesterol, albumin, prealbumin, Cr, 6-minute walk distance and forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) were lower in the sarcopenia group than those in the non-sarcopenia group (P<0.05). Multivariate logistic regression analysis showed that age, BMI, albumin, BUN/Cr and theFEV1/FVC were independent risk factors for sarcopenia in elderly COPD patients. ROC curve analysis was used to assess the predictive value of BUN/Cr for sarcopenia in the COPD patients, with an area under the ROC curve (AUC) of 0.725, an optimal cutoff point of 80.45, sensitivity of 60%, and specificity of 82.7%. A prediction model was constructed based on the above risk factors, with an AUC of 0.912 (95%CI 0.853-0.971), sensitivity of 80.0%, and specificity of 89.8%. The calibration curve of the prediction model fitted well. The decision curve analysis indicated that the nomogram had good clinical predictive performance within the threshold range of 0.2-0.8. Conclusion The BUN/Cr is associated with the development of sarcopenia in elderly COPD patients, and the predictive nomogram based on risk factors exhibits good performance for elderly COPD patients with concurrent sarcopenia.
