C-Reactive Protein, Procalcitonin, Clinical Pulmonary Infection Score, and Pneumonia Severity Scores in Nursing Home Acquired Pneumonia

Porfyridis, Ilias; Georgiadis, Georgios; Vogazianos, Paris; Mitis, Georgios; Georgiou, Andreas

doi:10.4187/respcare.02741

Cited by 43 publications

(50 citation statements)

References 31 publications

(68 reference statements)

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“…Several studies have demonstrated the usefulness of CURB65 in NHAP and HCAP [12][13][14] although it may show reduced discriminating ability as compared to its original use in CAP populations. This is demonstrated in our study by a nonsignificant inferior CURB65 ROC AUC comparison result between NHAP and CAP groups derived from the same original cohort [9].…”

Section: Discussionmentioning

confidence: 99%

Nursing home-acquired pneumonia presenting at the emergency department

2016

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Nursing home-acquired pneumonia (NHAP) is one of the most common infections arising amongst nursing home residents, and its incidence is expected to increase as population ages. The NHAP recommendation for empiric broad-spectrum antibiotic therapy, arising from the concept of healthcare-associated pneumonia, has been challenged by recent studies reporting low rates of multidrug-resistant (MDR) bacteria. This single center study analyzes the results of NHAP patients admitted through the Emergency Department (ED) at a tertiary center during the year 2010. There were 116 cases, male gender corresponded to 34.5 % of patients and median age was 84 years old . Comorbidities were present in 69.8 % of cases and 48.3 % of patients had used healthcare services during the previous 90 days. In-hospital mortality rate was 46.6 % and median length-of-stay was 9 days. Severity assessment at the Emergency Department provided CURB65 index score and respective mortality (%) results: zero: n = 0; one: n = 7 (0 %); two: n = 18 (38.9 %); three: n = 26 (38.5 %); four: n = 30 (53.3 %); and five; n = 22 (68.2 %); and sepsis n = 50 (34.0 %), severe sepsis n = 43 (48.8 %) and septic shock n = 22 (72.7 %). Significant risk factors for in-hospital mortality in multivariate analysis were polypnea (p = 0.001), age C 75 years (p = 0.02), and severe sepsis or shock (p = 0.03) at the ED. Microbiological testing in 78.4 % of cases was positive in 15.4 % (n = 15): methicillinresistant Staphylococcus aureus (26.7 %), Pseudomonas aeruginosa (20.0 %), S. pneumoniae (13.3 %), Escherichia coli (13.3 %), others (26.7 %); the rate of MDR bacteria was 53.3 %. This study reveals high rates of mortality and MDR bacteria among NHAP hospital admissions supporting the use of empirical broad-spectrum antibiotic therapy in these patients.

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Section: Discussionmentioning

confidence: 99%

Nursing home-acquired pneumonia presenting at the emergency department

2016

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“…The mean age of the patients varied between 53 and 82 years, and the proportion of men ranged from 18–98%. Thirteen studies included patients with CAP 11 with VAP, and one with nursing home‐acquired pneumonia . Nine studies, which included critically ill patients, were performed in ICU; six in ED; and six in HW .…”

Section: Resultsmentioning

confidence: 99%

Prognostic value of procalcitonin in pneumonia: A systematic review and meta‐analysis

Liú

Guan

et al. 2015

Respirology

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This meta‐analysis was performed to determine the accuracy of procalcitonin (PCT) in predicting mortality in pneumonia patients with different pathogenic features and disease severities. A systematic search of English‐language articles was performed using PubMed, Embase, Web of Knowledge and the Cochrane Library to identify studies. The diagnostic value of PCT in predicting prognosis was determined using a bivariate meta‐analysis model. The Q‐test and I 2 index were used to test heterogeneity. A total of 21 studies comprising 6007 patients were included. An elevated PCT level was a risk factor for death from community‐acquired pneumonia (CAP) (risk ratio (RR) 4.38, 95% confidence interval (CI) 2.98–6.43), particularly in patients with a low CURB‐65 score. The commonly used cut‐off, 0.5 ng/mL, had low sensitivity (SEN) and was not able to identify patients at high risk of dying. Furthermore, the PCT assay with functional SEN <0.1 ng/mL was necessary to predict mortality in CAP in the clinic. For critically ill patients, an elevated PCT level was associated with an increased risk of mortality (RR 4.18, 95% CI: 3.19–5.48). The prognostic performance was nearly equal between patients with ventilator‐associated pneumonia (VAP) and patients with CAP.

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“…Lee et al reported that the PSI had good predictive power for 30-day mortality in NHAP patients, but its AUC value was only 0.73 17. Porfyridis et al similarly reported that, among several pneumonia severity indicators, the CURB-65 scale had the highest accuracy for predicting the mortality of NHAP patients, but its AUC value was only 0.67 18. In short, these existing severity indicators have only an insufficient ability to predict the mortality of NHAP patients.…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of severity indicators of nursing-home-acquired pneumonia versus community-acquired pneumonia in elderly patients

Ugajin¹,

Yamaki²,

Hirasawa³

et al. 2014

CIA

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BackgroundThe credibility of prognostic indicators in nursing-home-acquired pneumonia (NHAP) is not clear. We previously reported a simple prognostic indicator in community-acquired pneumonia (CAP): blood urea nitrogen to serum albumin (B/A) ratio. This retrospective study investigated the prognostic value of severity indicators in NHAP versus CAP in elderly patients.MethodsPatients aged ≥65 years and hospitalized because of NHAP or CAP within the previous 3 years were enrolled. Demographics, coexisting illnesses, laboratory and microbiological findings, and severity scores (confusion, urea, respiratory rate, blood pressure, and age ≥65 [CURB-65] scale; age, dehydration, respiratory failure, orientation disturbance, and pressure [A-DROP] scale; and pneumonia severity index [PSI]) were retrieved from medical records. The primary outcome was mortality within 28 days of admission.ResultsIn total, 138 NHAP and 307 CAP patients were enrolled. Mortality was higher in NHAP (18.1%) than in CAP (4.6%) (P<0.001). Patients with NHAP were older and had lower functional status and a higher rate of do-not-resuscitate orders, heart failure, and cerebrovascular diseases. The NHAP patients more frequently had typical bacterial pathogens. Using the receiver-operating characteristics curve for predicting mortality, the area under the curve in NHAP was 0.70 for the A-DROP scale, 0.69 for the CURB-65 scale, 0.67 for the PSI class, and 0.65 for the B/A ratio. The area under the curve in CAP was 0.73 for the A-DROP scale, 0.76 for the CURB-65 scale, 0.81 for the PSI class, and 0.83 for the B/A ratio.ConclusionPatient mortality was greater in NHAP than in CAP. Patient characteristics, coexisting illnesses, and detected pathogens differed greatly between NHAP and CAP. The existing severity indicators had less prognostic value for NHAP than for CAP.

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C-Reactive Protein, Procalcitonin, Clinical Pulmonary Infection Score, and Pneumonia Severity Scores in Nursing Home Acquired Pneumonia

Cited by 43 publications

References 31 publications

Nursing home-acquired pneumonia presenting at the emergency department

Nursing home-acquired pneumonia presenting at the emergency department

Prognostic value of procalcitonin in pneumonia: A systematic review and meta‐analysis

Prognostic value of severity indicators of nursing-home-acquired pneumonia versus community-acquired pneumonia in elderly patients

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