Combining information from prognostic scoring tools for CAP: an American view on how to get the best of all worlds

Niederman, Michael S.; Feldman, Charles; Richards, Guy A.

doi:10.1183/09031936.06.00130305

Cited by 64 publications

(47 citation statements)

References 12 publications

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“…Several groups of investigators reported that this system is comparatively simple and it could identify severely ill individuals (1,15,17). By contrast, the pH value and blood glucose levels needed to calculate the PSI were not measured in 74.0% and 31.0% of the cases in the present study, respectively (data not shown), indicating that this index may not be practical for routine clinical use.…”

Section: Causative Organism Isolatescontrasting

confidence: 60%

Evaluation of an Assessment System for the JRS 2005: A-DROP for the Management of CAP in Adults

2011

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Objective The Japanese Respiratory Society (JRS) last revised the guidelines for community-acquired pneumonia (CAP) in adults in 2005. These guidelines proposed new criteria (A-DROP) to assess the severity of pneumonia and to differentiate between typical bacterial pneumonia and atypical pneumonia. The goal of the present study was to evaluate the utility of the A-DROP criteria for these described purposes. Methods An observational survey was conducted between July 2006 and March 2007, and patients with CAP were prospectively surveyed using consecutive enrollment methods. Patients In total, 1,875 patients from 200 medical facilities throughout Japan were analyzed. Results The JRS 2005 A-DROP system was a good indicator of mortality in the patient population, and these results were significantly correlated with the Pneumonia Severity Index (PSI) of the Infectious Disease Society of America (IDSA). Among the various factors characterized, 'SpO2 of 90% or less (PaO2 of 60 Torr or less)' was the strongest predictor of mortality. In terms of the differential diagnosis between typical bacterial and atypical pneumonia, five of six JRS 2005 items were strongly and significantly correlated with a diagnosis of atypical pneumonia. Conclusion The JRS 2005 A-DROP system was accurate and clinically useful for the assessment of the severity of pneumonia and for the differentiation between typical bacterial pneumonia and atypical pneumonia.

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Section: Causative Organism Isolatescontrasting

confidence: 60%

Evaluation of an Assessment System for the JRS 2005: A-DROP for the Management of CAP in Adults

2011

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“…In this meta-analysis, the DOR and AUC of the PORT score for predicting mortality were higher than those of CURB-65; as such, the PORT score may be a more useful tool for predicting mortality in HCAP patients than CURB-65. Compared to CURB-65, which is not sufficiently accurate for detecting patients with multiple comorbidities [29] , the PORT score has several benefits, in that this system can evaluate comorbidities and clinical parameters. However, the PORT score also is limited in that it may overes- timate the pneumonia severity in elderly patients with comorbidities and have relative complexity.…”

Section: Discussionmentioning

confidence: 99%

Pneumonia Severity Assessment Tools for Predicting Mortality in Patients with Healthcare-Associated Pneumonia: A Systematic Review and Meta-Analysis

et al. 2017

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Background: In contrast to community-acquired pneumonia (CAP), no specific severity assessment tools have been developed for healthcare-associated pneumonia (HCAP) in clinical practice. Objectives: In this review, we assessed the clinical significance of severity assessment tools for HCAP. Methods: We identified related articles from the PubMed database. The eligibility criteria were original research articles evaluating severity scoring tools and reporting the outcomes of mortality in patients with HCAP. Results: Eight articles were included in the meta-analysis. The PORT score and CURB-65 were evaluated in 7 and 8 studies, respectively. Using cutoff values of ≥IV and V for the PORT score, the diagnostic odds ratios (DORs) were 5.28 (2.49-11.17) and 3.76 (2.88-4.92), respectively, and the areas under the curve (AUCs) were 0.68 (0.64-0.72) and 0.71 (0.67-0.75), respectively. Conversely, the AUCs for ≥IV and V were 0.71 (0.67-0.76) and 0.74 (0.70-0.78), respectively, when applied only to nonimmunocompromised patients. In contrast, when using cutoff values of ≥2 and ≥3 for CURB-65, the DORs were 3.35 (2.26-4.97) and 2.65 (2.05-3.43), respectively, and the AUCs were 0.65 (0.61-0.69) and 0.66 (0.62-0.70), respectively. Conversely, the AUCs for ≥2 and ≥3 were 0.65 (0.61-0.69) and 0.68 (0.64-0.72), respectively, when applied only to nonimmunocompromised patients. Conclusions: The PORT score and CURB-65 do not have substantial power compared with the tools for CAP patients, although the PORT score is more useful than CURB-65 for predicting mortality in HCAP patients. According to our results, however, these tools, especially the PORT score, can be more useful when limited to nonimmunocompromised patients.

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“…In the last few years, prognostic scoring systems for CAP have been developed to stratify patients on the basis of their risk of mortality, but methods are not ideal (3 ). The most prominent and validated tool for this purpose, the pneumonia severity index (PSI) (1 ), is highly complex and can occasionally underestimate the gravity of CAP, especially in young patients without comorbid illnesses (2,4 ), because it heavily weights age and comorbidity and does not directly measure CAP-specific disease severity (3 ).…”

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confidence: 99%

Midregional Pro-A-Type Natriuretic Peptide and Carboxy-Terminal Provasopressin May Predict Prognosis in Community-Acquired Pneumonia

et al. 2007

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Background: Markers to better assess severity of disease in patients with community-acquired pneumonia (CAP) would help improve medical care of this condition. The hemodynamic biomarkers carboxy-terminal provasopressin (CT-proAVP; copeptin) and midregional proatrial natriuretic peptide (MR-proANP) are increased under septic conditions, in which MR-proANP has been described as a prognostic predictor. We aimed to explore the diagnostic accuracy of MR-proANP and CT-proAVP to predict mortality in patients with CAP. Methods: We conducted a prospective observational study of patients with CAP. We measured biomarkers in serum samples obtained at diagnosis and performed univariate and multivariate analyses to identify potential predictors of mortality.

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Combining information from prognostic scoring tools for CAP: an American view on how to get the best of all worlds

Cited by 64 publications

References 12 publications

Evaluation of an Assessment System for the JRS 2005: A-DROP for the Management of CAP in Adults

Evaluation of an Assessment System for the JRS 2005: A-DROP for the Management of CAP in Adults

Pneumonia Severity Assessment Tools for Predicting Mortality in Patients with Healthcare-Associated Pneumonia: A Systematic Review and Meta-Analysis

Midregional Pro-A-Type Natriuretic Peptide and Carboxy-Terminal Provasopressin May Predict Prognosis in Community-Acquired Pneumonia

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