Hypoxemia Adds to the CURB-65 Pneumonia Severity Score in Hospitalized Patients With Mild Pneumonia

Abstract

the Neumonía Adquirida en la Comunidad de la Comunidad Valenciana Study Group BACKGROUND: Hypoxemia may influence the prognosis of patients with mild pneumonia, regardless of the initial CURB-65 score (confusion, blood urea nitrogen > 20 mg/dL, respiratory rate > 30 breaths/min, blood pressure < 90/60 mm Hg, and age > 65 y). OBJECTIVE: To determine the risk factors associated with hypoxemia and the influence of hypoxemia on clinical outcomes in hospitalized patients with mild pneumonia. METHODS: We performed a multicenter prospective cohort study of 585 consecutive hospitalized patients with mild pneumonia (CURB-65 groups 0 and 1). We stratified the patients according to the presence of hypoxemia, defined as a P aO 2 / F IO 2 < 300 mm Hg on admission. We assessed the risk factors associated with hypoxemia, hypoxemia's influence on the course of pneumonia, and clinical outcomes (mortality, hospital stay, and need for intensive care unit admission), with multivariable regression. RESULTS: Fifty percent of the patients (294 cases) had hypoxemia on admission. The risk factors independently associated with hypoxemia were: bilateral radiological involvement (odds ratio 2.8, 95% CI 1.1-7.5), history of COPD (odds ratio 2.5, 95% CI 1.4 -4.3), and hypoalbuminemia (odds ratio 2.0, 95% CI 1.1-3.5). The hypoxemic patients had longer hospital stay, higher intensive care unit admission rate, higher rate of severe sepsis, and higher mortality than the non-hypoxemic patients. CONCLUSIONS: Hypoxemia in patients with mild pneumonia is independently associated with several adverse clinical and radiological variables, and the hypoxemic patients had worse clinical outcomes than the non-hypoxemic patients. Therefore, additional attention should be paid to the presence of hypoxemia, regardless of a low CURB-65 score.

Does prolonged onset of symptoms have a prognostic significance in community‐acquired pneumonia?

“…Hypoxemia and clinical judgment determined hospital admission in these patients. Indeed, 47.5% of CURB‐65 0–1 patients showed PaO 2 /FiO 2 <300 as we have published previously …”

Multimarker Prognostication for Hospitalized Patients with Community-acquired Pneumonia

“…First, the presence of dyspnea was an independent prognostic factor. This is in accordance with previous studies in which hypoxemia was found to be an independent prognostic factor in patients with pneumonia (15,16). In the present study, dyspnea correlated significantly with the PaO2/FiO2 ratio and the respiratory rate (r=-0.380, p<0.001; r=0.345, p<0.001, respectively).…”

Targets for antibiotic and healthcare resource stewardship in inpatient community-acquired pneumonia: a comparison of management practices with National Guideline Recommendations

“…This severity of illness indicator was not routinely used in our emergency department during the study period, and the majority of patients hospitalized with CAP had a score or 0 or 1. Moreover, nearly 30% had both a low CURB-65 score and absence of a new oxygen requirement, a marker of severity of illness that the CURB-65 score does not take into account [18]. Although social factors and/or comorbid conditions likely influenced the decision to hospitalize in some cases [19], admission may have been avoided in at least a subset of patients by using the CURB-65 score as an adjunct in the decision-making process.…”