Severity assessment of healthcare-associated pneumonia and pneumonia in immunosuppression

Abstract

The study compares the ability of the PSI (pneumonia severity index), CURB-65 (confusion, urea >7 mol·L(-1), respiratory rate ≥ 30 breaths·min(-1), blood pressure <90 mmHg systolic or ≤ 60 mmHg diastolic, and age ≥ 65 yrs), CURB and CRB-65 scales and the Severe Community-Acquired Pneumonia (SCAP) score to predict 30-day mortality in healthcare-associated pneumonia (HCAP) patients, and analyses differences in the demographics, aetiology and outcomes of community-acquired pneumonia (CAP), HCAP and pneumonia in immunocompromised patients. 629 consecutive patients admitted to a tertiary care university hospital were prospectively categorised as having CAP (n=322) or HCAP (n=307), and the HCAP patients were further sub-divided into those who were immunocompromised (n=219) or immunocompetent (n=88). The 30-day mortality rate was 9.0% in the CAP group and 24.1% in the HCAP group. In the HCAP group, the PSI and SCAP scores had similar prognostic power (area under the curve (AUC) of 0.68 and 0.67, respectively) and performed better than the CURB-65 score (AUC ≤0.62). Among the immunocompetent HCAP patients, the PSI and CURB-65 scores were more sensitive than the others at every threshold, whereas SCAP was more specific than both of these. In the immunocompromised group, the PSI was highly sensitive but poorly specific at all thresholds. Our results suggest that prognostic tools should be designed for subsets of HCAP patients.

I-ROAD could be efficient in predicting severity of community-acquired pneumonia or healthcare-associated pneumonia

“…(16) The findings of these studies suggest that the conventional prognostic guidelines used for CAP are not appropriate for the evaluation of HCAP severity. (15,16) In the present study, we found that I-ROAD correctly reflected the severity of CAP and HCAP, whereas A-DROP and CURB-65 underestimated the severity of both. PSI was useful in evaluating the severity of CAP and HCAP, but there was no statistically significant difference between the two groups.…”

“…Carrabba et al found that PSI and SCAP (severe community-acquired pneumonia) (14) are useful prognostic tools for immunocompetent patients, with the former noted to be highly sensitive but poorly specific for the evaluation of HCAP severity in immunocompromised patients with HCAP. (15) In a different study, Jeong et al demonstrated that the prognostic powers of PSI and CURB-65 for 30-day mortality were significantly lower for patients with HCAP than for patients with CAP. (16) The findings of these studies suggest that the conventional prognostic guidelines used for CAP are not appropriate for the evaluation of HCAP severity.…”

Clinical and microbiological features of patients admitted to the intensive care unit with nursing and healthcare-associated pneumonia

“…A previous report 26 showed prognostic scoring, including PSI, was good for predicting mortality in nonimmunocompromised patients with HCAP. Another study 27 also suggested that PSI could be applied to assess the severity of illness in the management of patients with HCAP, although the discriminatory powers of PSI for 30-day mortality were significantly lower in patients with HCAP compared with community-acquired pneumonia.…”

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

“…Recent reports have shown that 17.3-38.0% of outpatients with pneumonia suffer from HCAP [2][3][4][5][6] , and its mortality is about 20%, which is approximately twice that of communityacquired pneumonia (CAP) [7][8][9][10] .…”