1. bookVolume 59 (2021): Edizione 4 (December 2021)
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eISSN
2501-062X
Prima pubblicazione
30 Mar 2015
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4 volte all'anno
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access type Accesso libero

Evaluation of severity scoring systems in patients with severe community acquired pneumonia

Pubblicato online: 20 Nov 2021
Volume & Edizione: Volume 59 (2021) - Edizione 4 (December 2021)
Pagine: 394 - 402
Ricevuto: 04 May 2021
Dettagli della rivista
License
Formato
Rivista
eISSN
2501-062X
Prima pubblicazione
30 Mar 2015
Frequenza di pubblicazione
4 volte all'anno
Lingue
Inglese
Abstract

Background. The aim of this study was to evaluate the ability of severity scoring systems to predict 30-day mortality in patients with severe community-acquired pneumonia.

Methods. The study included 98 patients aged ≥18 years with community acquired pneumonia hospitalized at the Intensive Care Unit of the University Clinic for Infectious Diseases in Skopje, Republic of North Macedonia, during a 3-year period. We recorded demographic, clinical and common biochemical parameters. Five severity scores were calculated at admission: CURB 65 (Confusion, Urea, Respiratory Rate, Blood pressure, Age ≥65 years), SCAP (Severe Community Acquired Pneumonia score), SAPS II (Simplified Acute Physiology Score), SOFA (Sequential Organ Failure Assessment Score) and MPM (Mortality Prediction Model). Primary outcome variable was 30-day in-hospital mortality.

Results. The mean age of the patients was 59.08 ± 15.76 years, predominantly males (68%). The overall 30-day mortality was 52%. Charlson Comorbidity index was increased in non-survivors (3.72 ± 2.33) and was associated with the outcome. All severity indexes had higher values in patients who died, that showed statistical significance between the analysed groups. The areas under curve (AUC) values of the five scores for 30-day mortality were 0.670, 0.732, 0,726, 0.785 and 0.777, respectively.

Conclusion. Widely used severity scores accurately detected patients with pneumonia that had increased risk for poor outcome, but none of them individually demonstrated any advantage over the others.

Keywords

1. ASHLEY C. RIDER, BRADLEY W. FRAZEE. Community-acquired pneumonia. Emerg Med Clin North Am. 2018 Nov; 36(4): 665–683.10.1016/j.emc.2018.07.001 Search in Google Scholar

2. PRINA E, RANZANI OT, TORRES A. Community-acquired pneumonia. Lancet. 2015 Sep 12;386(9998):1097–108.10.1016/S0140-6736(15)60733-4 Search in Google Scholar

3. MUSHER DM, THORNER AR. Community-acquired pneumonia. N Engl J Med. 2014 Oct 23; 371(17):161928.10.1056/NEJMra1312885 Search in Google Scholar

4. JOSE GARNACHO-MONTERO, IRENE BARRERO-GARCÍA, MARIA DE GRACIA GÓMEZ-PRIETO & IGNACIO MARTÍN-LOECHES. Severe community-acquired pneumonia: current management and future therapeutic alternatives, Expert Review of Anti-infective Therapy, 2018 Sept;16(9):667–677.10.1080/14787210.2018.1512403 Search in Google Scholar

5. MORGAN AJ, GLOSSOP AJ. Severe community-acquired pneumonia.BJA Education.2016; 16(5): 167–172.10.1093/bjaed/mkv052 Search in Google Scholar

6. EWIG S, SCHAFER H, TORRES A. Severity assessment in community-acquired pneumonia. Eur Respir J. 2000; 16(6):1193–201.10.1034/j.1399-3003.2000.16f27.x Search in Google Scholar

7. NEUHAUS T, EWIG S. Defining severe community-acquired pneumonia. Med Clin North Am. 2001;85(6):1413–25.10.1016/S0025-7125(05)70388-6 Search in Google Scholar

8. METLAY JP 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 Respir Crit Care Med. 2019 Oct 1;200(7):e45-e67.10.1164/rccm.201908-1581ST681243731573350 Search in Google Scholar

9. FINE MJ, AUBLE TE, YEALY DM, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997; 336:243–250.10.1056/NEJM1997012333604028995086 Search in Google Scholar

10. British Thoracic Society Standards of Care Committee. BTS Guidelines for the Management of Community Acquired Pneumonia in Adults. Thorax. 2001;56 Suppl 4: IV1-64.10.1136/thx.56.suppl_4.iv1 Search in Google Scholar

11. ESPAÑA PP, CAPELASTEGUI A, GORORDO I, ESTEBAN C, ORIBE M, ORTEGA M, BILBAO A, QUINTANA JM. Development and validation of a clinical prediction rule for severe community-acquired pneumonia. Am J Respir Crit Care Med. 2006 Dec 1;174(11):1249–56.10.1164/rccm.200602-177OC16973986 Search in Google Scholar

12. NIEDERMAN MS, MANDELL LA, ANZUETO A et al. American Thoracic Society. Guidelines for the management of adults with community-acquired pneumonia. Diagnosis, assessment of severity, antimicrobial therapy, and prevention. Am J Respir Crit Care Med. 2001 Jun; 163(7):1730–54.10.1164/ajrccm.163.7.at101011401897 Search in Google Scholar

13. LE GALL JR, LEMESHOW S, SAULNIER F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA. 1993 Dec 22-29;270(24):2957–63.10.1001/jama.270.24.29578254858 Search in Google Scholar

14. LAMBDEN S, LATERRE PF, LEVY MM, FRANCOIS B. The SOFA score-development, utility and challenges of accurate assessment in clinical trials. Crit Care. 2019 Nov 27;23(1):374.10.1186/s13054-019-2663-7688047931775846 Search in Google Scholar

15. GODINJAK A, IGLICA A, RAMA A, TANČICA I, JUSUFOVIĆ S, AJANOVIĆ A, KUKULJAC A. Predictive value of SAPS II and APACHE II scoring systems for patient outcome in a medical intensive care unit. Acta Med Acad. 2016 Nov;45(2):97–103.10.5644/ama2006-124.16528000485 Search in Google Scholar

16. SALLUH JI, SOARES M. ICU severity of illness scores: APACHE, SAPS and MPM. Curr Opin Crit Care. 2014 Oct;20(5):557–65.10.1097/MCC.000000000000013525137401 Search in Google Scholar

17. GROZDANOVSKI K, MILENKOVIC Z, STOJOVSKA KALAMARAS P at al. Findings after the analysis of the structure of the patients hospitalized in a six-year period. MMR 2003;53 (Supp 37):178–179. Search in Google Scholar

18. MORTENSEN EM, COLEY CM, SINGER DE, et al. Causes of death for patients with community-acquired pneumonia: results from the Pneumonia Patient Outcomes Research Team cohort study. Arch Intern Med 2002;162: 1059–1064.10.1001/archinte.162.9.105911996618 Search in Google Scholar

19. KOTHE H, BAUER T, MARRE R, SUTTORP N, WELTE T, DALHOFF K; Competence Network for Community-Acquired Pneumonia study group. Outcome of community acquired pneumonia: influence of age, residence status and antimicrobial treatment. Eur Respir J. 2008 Jul;32(1):139–46.10.1183/09031936.0009250718287129 Search in Google Scholar

20. PATTERSON C.M., LOEBINGER M.R. Community acquired pneumonia: Assessment and treatment. Clin Med (Lond). 2012 Jun;12(3):283–6.10.7861/clinmedicine.12-3-283495349622783785 Search in Google Scholar

21. KOLDITZ M, EWIG S, KLAPDOR B, SCHUTTE H, WINNING J, RUPP J et al. Community-acquired pneumonia as medical emergency: predictors of early deterioration. Thorax 2015; 70: 551–58.10.1136/thoraxjnl-2014-20674425782758 Search in Google Scholar

22. BRANCARTI FL, CHOW JW, WAGENER MM, et al. Is pneumonia really the old man’s friend? Two-year prognosis after community-acquired pneumonia. Lancet 1993; 342:30–33.10.1016/0140-6736(93)91887-R Search in Google Scholar

23. BAHLIS LF, DIOGO LP, FUCHS SC. Charlson Comorbidity Index and other predictors of in-hospital mortality among adults with community-acquired pneumonia. J Bras Pneumol. 2021 Feb 24;47(1):e20200257.10.36416/1806-3756/e20200257833267233656092 Search in Google Scholar

24. WESEMANN T, NÜLLMANN H, PFLUG MA, HEPPNER HJ, PIENTKA L, THIEM U. Pneumonia severity, comorbidity and 1-year mortality in predominantly older adults with community-acquired pneumonia: a cohort study. BMC Infect Dis. 2015;15:2.10.1186/s12879-014-0730-x430477425566688 Search in Google Scholar

25. MULLER B, HARBARTH S, STOLZ D, BINGISSER R, MUELLER C, LEUPPI J, NUSBAUMER C, TAMM M, CHRIST-CRAIN M. Diagnostic and prognostic accuracy of clinical and laboratory parameters in community-acquired pneumonia. BMC Infect Dis. 2007; 7:10.10.1186/1471-2334-7-10182103117335562 Search in Google Scholar

26. ABDEL AZIZ AO, ABDEL FATTAH M T, MOHAMED AH, ABDEL AZIZ MO, MOHAMMED MS. Mortality predictors in patients with severe community-acquired pneumonia requiring ICU admission. Egypt J Bronchology, 2016; 10 (2): 155–161.10.4103/1687-8426.184373 Search in Google Scholar

27. ITO A, ISHIDA T, TOKUMASU H, WASHIO Y, YAMAZAKI A, ITO Y, TACHIBANA H. Prognostic factors in hospitalized community-acquired pneumonia: a retrospective study of a prospective observational cohort. BMC Pulm Med. 2017 May 2;17(1):78.10.1186/s12890-017-0424-4541434328464807 Search in Google Scholar

28. NING P, ZHENG Y, LUO Q, LIU X, KANG Y, ZHANG Y, ZHANG R, XU Y, YANG D, XI W, WANG K, CHEN Y, AN S, GAO Z. Metabolic profiles in community-acquired pneumonia: developing assessment tools for disease severity. Crit Care. 2018 May 14;22(1):130.10.1186/s13054-018-2049-2595282929759075 Search in Google Scholar

29. HUANG Y, LIU A, LIANG L, JIANG J, LUO H, DENG W, LIN G, WU M, LI T, JIANG Y. Diagnostic value of blood parameters for community-acquired pneumonia. Int Immunopharmacol. 2018 Nov;64:10–15.10.1016/j.intimp.2018.08.02230144639 Search in Google Scholar

30. UGAJIN M, YAMAKI K, HIRASAWA N, YAGI T. Predictive values of semi-quantitative procalcitonin test and common biomarkers for the clinical outcomes of community-acquired pneumonia. Respir Care. 2014;59: 564–73.10.4187/respcare.0280724170911 Search in Google Scholar

31. SIBILA O, RESTREPO MI. Biomarkers in community-acquired pneumonia: still searching for the one. Eur Respir J. 2019 Feb 28; 53(2):1802469.10.1183/13993003.02469-201830819808 Search in Google Scholar

32. AKAGI T, NAGATA N, MIYAZAKI H, HARADA T, TAKEDA S, YOSHIDA Y, WADA K, FUJITA M, WATANABE K. Procalcitonin is not an independent predictor of 30-day mortality, albeit predicts pneumonia severity in patients with pneumonia acquired outside the hospital. BMC Geriatr. 2019 Jan 7;19(1):3.10.1186/s12877-018-1008-8632370230616612 Search in Google Scholar

33. AUJESKY D, AUBLE TE, YEALY DM, STONE RA, OBROSKY DS, MEEHAN TP, et al. Prospective comparison of three validated prediction rules for prognosis in community-acquired pneumonia. Am J Med 2005; 118: 384–92.10.1016/j.amjmed.2005.01.00615808136 Search in Google Scholar

34. MAN SY, LEE N, IP M, ANTONIO GE, CHAU SS, MAK P, et al. Prospective comparison of three predictive rules for assessing severity of community-acquired pneumonia in Hong Kong. Thorax 2007; 62: 348–53.10.1136/thx.2006.069740209247617121867 Search in Google Scholar

35. BUISING KL, THURSKY KA, BLACK JF, MACGREGOR L, STREET AC, KENNEDY MP, et al. A prospective comparison of severity scores for identifying patients with severe community acquired pneumonia: reconsidering what is meant by severe pneumonia. Thorax 2006; 61: 419–24.10.1136/thx.2005.051326211117416449258 Search in Google Scholar

36. ESPANA PP, CAPELASTEGUI A, QUINTANA JM, BILBAO A, DIEZ R, PASCUAL S, et al. Validation and comparison of SCAP as a predictive score for identifying low-risk patients in community-acquired pneumonia. J Infect 2010; 60: 106–13.10.1016/j.jinf.2009.11.01319961875 Search in Google Scholar

37. CHALMERS JD, MANDAL P, SINGANAYAGAM A, AKRAM AR, CHOUDHURY G, SHORT PM, HILL AT: Severity assessment tools to guide ICU admission in community-acquired pneumonia: systematic review and meta-analysis. Intensive Care Med 2011, 37:1409–1420.10.1007/s00134-011-2261-x21660535 Search in Google Scholar

38. MARTI et al. Prediction of severe community-acquired pneumonia: a systematic review and meta-analysis. Critical Care 2012, 16: R141.10.1186/cc11447358072722839689 Search in Google Scholar

39. KĄDZIOŁKA I, ŚWISTEK R, BOROWSKA K, TYSZECKI P, SEREDNICKI W. Validation of APACHE II and SAPS II scales at the intensive care unit along with assessment of SOFA scale at the admission as an isolated risk of death predictor. Anaesthesiol Intensive Ther. 2019;51(2):107-111.10.5114/ait.2019.8627531268271 Search in Google Scholar

40. ALICI IO, CAPAN N, ERTURK A, CANBAKAN S. Comparison of Severity Scoring Systems in Community-Acquired Pneumonia. Eurasian J Pulmonol 2015; 17: 15–21.10.5152/ejp.2014.68077 Search in Google Scholar

41. HANIFFA R, ISAAM I, DE SILVA AP, DONDORP AM, DE KEIZER NF. Performance of critical care prognostic scoring systems in low and middle-income countries: a systematic review. Crit Care. 2018 Jan 26;22(1):18.10.1186/s13054-017-1930-8578723629373996 Search in Google Scholar

42. KEEGAN MT, GAJIC O, AFESSA B. Severity of illness scoring systems in the intensive care unit. Crit Care Med. 2011 Jan;39(1):163–9.10.1097/CCM.0b013e3181f96f8120838329 Search in Google Scholar

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