Simplified Prediction Rule for Prognosis of Patients With Severe Community-Acquired Pneumonia in ICUs

Leroy, Olivier; Devos, Patrick; Guery, Benoît; Georges, H.; Vandenbussche, C.; Coffinier, C; Thévenin, Didier; Beaucaire, G.

doi:10.1378/chest.116.1.157

Cited by 55 publications

(39 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The percentage of patients aged o65 yrs admitted to the ICU (2.9%), the mean age of the total number of patients admitted to the ICU (60.6 yrs) and the mortality rate among patients admitted to ICU (11.1%) are lower than those reported in other studies [15,16]. In the current study, older age may have been used as a restrictive criterion for ICU admission.…”

contrasting

confidence: 63%

Validation of a predictive rule for the management of community-acquired pneumonia

Capelastegui

España²,

Quintana³

et al. 2006

European Respiratory Journal

325

213

View full text Add to dashboard Cite

The CURB-65 score (Confusion, Urea .7 mmol?L -1 , Respiratory rate o30?min, low Blood pressure, and age o65 yrs) has been proposed as a tool for augmenting clinical judgement for stratifying patients with community-acquired pneumonia (CAP) into different management groups.The six-point CURB-65 score was retrospectively applied in a prospective, consecutive cohort of adult patients with a diagnosis of CAP seen in the emergency department of a 400-bed teaching hospital from March 1, 2000 to February 29, 2004. A total of 1,100 inpatients and 676 outpatients were included.The 30-day mortality rate in the entire cohort increased directly with increasing CURB-65 score: 0, 1.1, 7.6, 21, 41.9 and 60% for CURB-65 scores of 0, 1, 2, 3, 4, and 5, respectively. The score was also significantly associated with the need for mechanical ventilation and rate of hospital admission in the entire cohort, and with duration of hospital stay among inpatients.The CURB-65 score (Confusion, Urea .7 mmol?L -1, Respiratory rate o30?min, low Blood pressure, and age o65 yrs), and a simpler CRB-65 score that omits the blood urea measurement, helps classify patients with community-acquired pneumonia into different groups according to the mortality risk and significantly correlates with community-acquired pneumonia management key points. The new score can also be used as a severity adjustment measure.

show abstract

contrasting

confidence: 63%

Validation of a predictive rule for the management of community-acquired pneumonia

Capelastegui

España²,

Quintana³

et al. 2006

European Respiratory Journal

325

213

View full text Add to dashboard Cite

show abstract

“…Unfortunately, comparison with other studies is hampered by lack of a consistent definition of "comorbid illnesses" and difficulties in grading the severity of each of these illnesses. Nevertheless, there are now at least five other studies of CAP in the elderly, two conducted in Intensive Care Units, which have not found any association between comorbid illness and mortality [4,5,10,11,13]. Respiratory rate, blood urea and confusion were not found to be independently associated with mortality; the key factors that comprise the BTS mortality severity score.…”

Section: Discussionmentioning

confidence: 91%

Defining prognostic factors in the elderly with community acquired pneumonia: a case controlled study of patients aged ≥75 yrs

Lim

Jt²

2001

Eur Respir J

View full text Add to dashboard Cite

Defining prognostic factors in the elderly with community acquired pneumonia: a case controlled study of patients aged ¢75 yrs. W.-S. Lim, J.T. Macfarlane. #ERS Journals Ltd 2001. ABSTRACT: Severity assessment in the elderly with community acquired pneumonia (CAP) may be different compared with younger patients. In particular, age per se may not be of prognostic significance in older patients. A case-control study in 158 patients aged ¢75 yrs with CAP was conducted to determine the factors associated with in-hospital mortality.Cases were drawn from all patients aged ¢75 yrs with CAP who died in 1997 in five hospitals in the mid-Trent region of the UK (Nottingham City Hospital, University Hospital Nottingham, Derby Royal Infirmary, Derby City General Hospital and Kings Hill Hospital). Controls were randomly selected from survivors also aged ¢75 yrs. Factors associated with mortality were identified following a review of the medical casenotes and the contribution of these factors to mortality was determined using multivariate analysis.Absence of fever, tachycardia and chest radiograph features of bilateral involvement or an effusion were independently associated with mortality on multivariate analysis. The British Thoracic Society (BTS) severity rule was 50% sensitive and 64% specific in predicting death while the modified BTS rule displayed 67% sensitivity and 58% specificity.Age was not significantly associated with mortality in this group of patients aged ¢75 yrs. Similarly, the clinical features employed in the British Thoracic Society rule, namely respiratory rate, diastolic blood pressure and blood urea, were not of prognostic significance and the rule itself performed poorly. The modified British Thoracic Society rule performed better.

show abstract

“…Only recently, another interesting prediction rule for mortality from severe CAP treated in ICUs has been proposed [36]. In this study of 472 eligible patients with severe CAP, the following six variables available at initial evaluation were independently associated with death: 1) age $40 yrs, 2) anticipated death within 5 yrs, 3) nonaspiration pneumonia, 4) chest radiograph involvement >1 lobe, 5) acute respiratory failure requiring mechanical ventilation, and 6) septic shock.…”

Section: Risk Score Assessmentmentioning

confidence: 89%

Severity assessment in community-acquired pneumonia

Ewig¹,

Schäfer²,

Torres³

2000

Eur Respir J

View full text Add to dashboard Cite

In current guidelines for the management of adults with community‐acquired pneumonia (CAP), the triaging decision about hospitalization or intensive care unit (ICU) admission, and, as a consequence, selection of initial antimicrobial treatment is largely based on the assessment of pneumonia severity. The proposed severity criteria are mainly derived from studies determining pre‐dictors of adverse outcome. These include age, male sex, comorbidity, acute respira‐tory failure, severe sepsis and septic shock, extension of radiographic infiltrates, bacteraemia and CAP through several different pathogens such as Streptococcus pneumoniae, Staphylococcus aureus, Gram‐negative enteric bacilli (GNEB), and signs of disease progression within the first 48–72 h. In addition, prediction rules and need for a complicated course in ambulatory and hospitalized patients, for the individual risk of death have been developed which may be helpful in determining the patient who might require hospitalization or intensive care, respectively. Risk classifications such as the scores developed by F ineet al. [40] are not only useful for identifying low risk patients who might safely be treated as outpatients, but apparently they will also play a major role in the evaluation of processes and outcomes of care for patients with CAP. Recent investigations have provided objective criteria for the definition of severe CAP requiring ICU admission. Whether the detection of infiltrates in the chest radiographs of patients with acute lower respiratory tract infection (LRTI) suggestive of mild pneumonia has an independent prognostic impact which fundamentally affects the concept of mild LRTI remains to be seen. Based on objective criteria for severity assessment it will be possible to define interventions aimed at reducing hospital admission rates, define a risk‐adapted anti‐microbial treatment regimen, reduce costs for antimicrobial treatment and supportive measures, shorten hospital stay, and, thereby, improve the quality of care for patients with community‐acquired pneumonia.

show abstract

Simplified Prediction Rule for Prognosis of Patients With Severe Community-Acquired Pneumonia in ICUs

Cited by 55 publications

References 20 publications

Validation of a predictive rule for the management of community-acquired pneumonia

Validation of a predictive rule for the management of community-acquired pneumonia

Defining prognostic factors in the elderly with community acquired pneumonia: a case controlled study of patients aged ≥75 yrs

Severity assessment in community-acquired pneumonia

Contact Info

Product

Resources

About