1. bookVolume 29 (2021): Issue 1 (January 2021)
Journal Details
License
Format
Journal
eISSN
2284-5623
First Published
08 Aug 2013
Publication timeframe
4 times per year
Languages
English
access type Open Access

The role of qSOFA score and biomarkers in assessing severity of community-acquired pneumonia in adults

Published Online: 29 Jan 2021
Page range: 65 - 75
Received: 03 Jul 2020
Accepted: 01 Nov 2020
Journal Details
License
Format
Journal
eISSN
2284-5623
First Published
08 Aug 2013
Publication timeframe
4 times per year
Languages
English
Abstract

Introduction: Community-acquired pneumonia (CAP) is the primary cause of severe sepsis. Severity assessment scores have been created, in order to help physicians decide the proper management of CAP. The purpose of this study was to examine the correlations between different CAP severity scores, including qSOFA, several biomarkers and their predictive value in the 30 day follow-up period, regarding adverse outcome.

Materials and methods: One hundred and thirty nine adult patients with CAP, admitted in the Teaching Hospital of Infectious Diseases, Cluj-Napoca, Romania from December 2015 to February 2017, were enrolled in this study. Pneumonia Severity Index (PSI), CURB-65, SMART-COP and the qSOFA scores were calculated at admittance. Also, C-reactive protein (CRP), procalcitonin (PCT) and albumin levels were used to determine severity.

Results: The mean PSI of all patients was 93.30±41.135 points, for CURB-65 it was 1.91±0.928 points, for SMART-COP it was 1.69±1.937 points. The mean qSOFA was 1.06±0.522 points, 21 (14.9%) were at high risk of in-hospital mortality. In the group of patients with qSOFA of ≥2, all pneumonia severity scores and all biomarkers tested were higher than those with scores <2. We found significant correlations between biomarkers and severity scores, but none regarding adverse outcome.

Conclusion: The qSOFA score is easier to use and it is able to accurately evaluate the severity of CAP, similar to other scores. Biomarkers are useful in determining the severity of the CAP. Several studies are needed to assess the prediction of these biomarkers and severity scores in pneumonia regarding adverse outcome.

Keywords

1. Antunes G, Evans SA, Lordan JL, Frew AJ. Systemic cytokines levels in community-acquired pneumonia and their association with disease severity. Eur Respir J. 2002 Oct;20 (4):990–5. DOI: 10.1183/09031936.02.0029510210.1183/09031936.02.0029510212412694Search in Google Scholar

2. Community-Acquired Pneumonia (CAP): Practice Essentials, Overview, Etiology of Community-Acquired Pneumonia [Online]. [2017] [cited February 2020]; Available from: URL: https://emedicine.medscape.com/article/234240-overview.Search in Google Scholar

3. Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997 Jan;336(4):243–50. DOI: 10.1056/NEJM19970123336040210.1056/NEJM1997012333604028995086Search in Google Scholar

4. Lim WS, van der Eerden MM, Laing R, Boersma WG, Karalus N, Town GI, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 2003 May;58(5):377–82. DOI: 10.1136/thorax.58.5.37710.1136/thorax.58.5.377174665712728155Search in Google Scholar

5. [Online]. 2019 [cited February 2020]. Available from: URL: https://lifeinthefastlane.com/wp-content/uploads/2010/07/etg-smartcop.Search in Google Scholar

6. Almirall J, Bolibar I, Toran P, Pera G, Boquet X, Balanzo X, et al. Contribution of C-reactive protein to the diagnostic and assessment of severity of community-acquired pneumonia. Chest. 2004 Apr;125(4):1335–42. DOI: 10.1378/chest.125.4.133510.1378/chest.125.4.133515078743Search in Google Scholar

7. Christ-Crain M, Stolz D, Bingisser R, Muller C, Miedlinger D, Huber PR, et al. Procalcitonin guidance of antibiotic therapy in community-acquired pneumonia: a randomized trial. Am J Respir Crit Care Med. 2006 Jul;174(1):84–93. DOI: 10.1164/rccm.200512-1922OC10.1164/rccm.200512-1922OC16603606Search in Google Scholar

8. Magnussen B, Oren Gradel K, Gorm Jensen T, Kolmos HJ, Pedersen C, Just Vinholt P, et al. Association between Hypoalbuminaemia and Mortality in Patients with Community-Acquired Bacteraemia Is Primarily Related to Acute Disorders. PLoS ONE. 2016 Sep;11(9): e0160466. DOI: 10.1371/journal. pone.0160466Search in Google Scholar

9. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third International Consensus definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016 Feb;315(8):801–10. DOI: 10.1001/jama.2016.028710.1001/jama.2016.0287496857426903338Search in Google Scholar

10. Raith EP, Udy AA, Bailey M, McGloughlin S, MacIsaac C, Bellomo R, et al. Prognostic accuracy of SOFA score, SIRS criteria and qSOFA score for in-hospital mortality among adults with suspected infection admitted to the Intensive Care Unit. JAMA. 2017 Jan;317(3):290–300. DOI: 10.1001/jama.2016.2032810.1001/jama.2016.2032828114553Search in Google Scholar

11. Asai N, Watanabe H, Shiota A, Kato H, Sakanashi D, Hagihara M, et al. Efficacy and accuracy of q SOFA and SOFA scores as prognostic tools for community-acquired and healthcare-associated pneumonia. Int J Infect Dis. 2019 Jul;84:89–96. DOI: 10.1016/j. ijid.2019.04.020Search in Google Scholar

12. Tripon RE, Neagoe IB, Budisan L, Pop TL, Cristea V, Stanca LM, et al. Systemic interleukins levels in community-acquired pneumonia and their association with adverse outcomes. Rev Romana Med Lab. 2019;27(2):189–98. DOI: 10.2478/rrlm-2019-002010.2478/rrlm-2019-0020Search in Google Scholar

13. Metlay JP, Waterer GW, Long AC, Anzueto A, Brozek J, Crothers K, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respire Crit Care Med. 2019 Oct;200(7):e45–e67. DOI: 10.1164/rccm.201908-1581ST10.1164/rccm.201908-1581ST681243731573350Search in Google Scholar

14. Bone R, Balk R, Cerra F, Dellinger R, Fein A, Knaus W, et al. Definitions for Sepsis and Organ Failure and Guidelines for the Use of Innovative Therapies in Sepsis. The ACCP/SCCM Consensus Conference Committee. Amrican College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992 Jun;101(6):1644–55. DOI: 10.1378/chest.101.6.164410.1378/chest.101.6.16441303622Search in Google Scholar

15. Gutiérrez F, Masiá M, Mirete C, Soldán B, Carlos Rodríguez J, Padilla S, et al. The influence of age and gender on the population-based incidence of community-acquired pneumonia caused by different microbial pathogens. J Infect. 2006 Sep;53(3):166–74. DOI: 10.1016/j.jinf.2005.11.00610.1016/j.jinf.2005.11.00616375972Search in Google Scholar

16. Rozenbaum M, Mangen M, Huijts S, van der Werf T, Postma M. Incidence, direct costs and duration of hospitalization of patients hospitalized with community acquired pneumonia: A nationwide retrospective claims database analysis. Vaccine. 2015 Jun;33(28):3193–9. DOI: 10.1016/j.vaccine.2015.05.00110.1016/j.vaccine.2015.05.00125981488Search in Google Scholar

17. Garau J, Baquero F, Pérez-Trallero E, Pérez J, Martín-Sánchez A, García-Rey C, et al. Factors impacting on length of stay and mortality of community-acquired pneumonia. Clin Microbiol Infect. 2008 Apr;14(4):322–9. DOI: 10.1111/j.1469-0691.2007.01915.x10.1111/j.1469-0691.2007.01915.x18190569Search in Google Scholar

18. Song H, Moon GH, Kim HS. Efficacy of quick SOFA with lactate concentration for predicting mortality in patients with community-acquired pneumonia in the emergency department. Clin Exp Emerg Med. 2019 Mar;6(1):1–8. DOI: 10.15441/ceem.17.26210.15441/ceem.17.262645369830781940Search in Google Scholar

19. Chen XY, Wang JY, Guo SB. Use of CRB-65 and quick SOFA to predict site of care and mortality in pneumonia patients in the emergency department: a retrospective study. Crit Care. 2016 Jun;20(1):167. DOI: 10.1186/s13054-016-1351-010.1186/s13054-016-1351-0488849527250351Search in Google Scholar

20. Dosanjh DPS, Grudzinska F, Aldridge K, Hughes S, Thickett D. Risk stratification in community acquired pneumonia-CURB65, SIRS or qSOFA? A retrospective analysis. Thorax. 2017 Dec;72(Suppl 3): A8.2-A9. DOI: 10.1136/thoraxjnl-2017-210983.1410.1136/thoraxjnl-2017-210983.14Search in Google Scholar

21. Tokioka F, Okamoto H, Yamazaki A, Itou A, Ishida T. The prognostic performance of qSOFA for community acquired pneumonia. J Intensive Care. 2018 Aug;6:46. DOI: 10.1186/s40560-018-0307-710.1186/s40560-018-0307-7608358430116532Search in Google Scholar

22. Anhert P, Creutz P, Horn K, Schwarzenberger F, Kiehntopf M, Hossain H, et al. Sequential organ failure assessment score in an excellent operationalization of disease severity of adult patients with hospitalized community acquired pneumonia-results from the prospective observational PROGRESS study. Crit Care. 2019 Apr;23:110. DOI: 10.1186/s13054-019-2316-x10.1186/s13054-019-2316-x645000230947753Search in Google Scholar

23. Shaddock EJ. How and when to use common biomarkers in community-acquired pneumonia. Pneumonia (Nathan). 2016 Oct;8:17. DOI: 10.1186/s41479-016-0017-710.1186/s41479-016-0017-7547170428702296Search in Google Scholar

24. Naderi HR, Sheybani F, Sarvghad M, Nooghabi MJ. Can procalcitonin add to the prognostic power of the severity scoring system in adults with pneumonia? Tanaffos. 2015;14(2):95–106.Search in Google Scholar

25. Chalmers JD, Singanayagam A, Hill AT. C-reactive protein is an independent predictor of severity in community-acquired pneumonia. Am J Med. 2008 Mar;121(3):219–25. DOI: 10.1016/j.amjmed.2007.10.03310.1016/j.amjmed.2007.10.03318328306Search in Google Scholar

26. Thiem U, Niklaus D, Sehloff B, Stuckle C, Heppner HJ, Endres HG, et al. C-reactive protein, severity of pneumonia and mortality in elderly, hospitalised patients with community-acquired pneumonia. Age Ageing. 2009 Nov;38(6):693–7. DOI: 10.1093/ageing/afp16410.1093/ageing/afp16419729453Search in Google Scholar

27. Nicholson JP, Wolmarans MR, Park GR. The role of albumin in critical illness. Br J Anaesth. 2000 Oct;85(4):599–610. DOI: 10.1093/bja/85.4.59910.1093/bja/85.4.59911064620Search in Google Scholar

28. Lee JH, Kim J, Kim K, Jo YH, Rhee J, Kim TY, et al. Albumin and C-reactive protein have prognostic significance in patients with community-acquired pneumonia. J Crit Care. 2011 Jun;26(3):287–94. DOI: 10.1016/j.jcrc.2010.10.00710.1016/j.jcrc.2010.10.00721129911Search in Google Scholar

29. Viasus D, Garcia-Vidal C, Simionetti A, Manresa F, Dorca J, Gudoil F, et al. Prognostic value of serum albumin levels in hospitalized adults with community-acquired pneumonia. J Infect. 2013 May;66(5):415–23. DOI: 10.1016/j.jinf.2012.12.00710.1016/j.jinf.2012.12.00723286966Search in Google Scholar

30. Magnussen B, Oren Gradel K, Gorm JT, Kolmos HJ, Pedersen C, Just Vinholt P, et al. Association between hypoalbuminemia and mortality in patients with community-acquired bacteraemia is primarily related to acute disorders. PLos One. 2016 Sep;11(9):e0160466. DOI: 10.1371/journal.pone.016046610.1371/journal.pone.0160466501770427611431Search in Google Scholar

Recommended articles from Trend MD

Plan your remote conference with Sciendo