Abstract
Background
The Infectious Disease Society of America/the American Thoracic Society (IDSA/ATS)
minor criteria for severe community-acquired pneumonia (CAP) are of unequal weight
in predicting mortality. It is unclear whether the patients with non-severe CAP meeting
the minor criteria most strongly associated to mortality should have the priority
for treatment and intensive care. It is warranted to explore this intriguing hypothesis.
Methods
A retrospective cohort study of 1230 patients with CAP was performed. This was tested
against a prospective 2-center cohort of 1749 adults with CAP.
Results
The patients with CAP fulfilling the predictive findings most strongly associated
to mortality, i.e. PaO2/FiO2 ≤ 250 mm Hg, confusion, and uremia, showed higher mortality
rates than those not fulfilling the predictive findings in subgroup analyses of the
retrospective cohort. The more the number of predictive findings present, the higher
the mortality rates. The prospective cohort confirmed a similar pattern. Interestingly,
the patients with non-severe CAP meeting the predictive findings demonstrated unexpectedly
higher mortality rates compared with the patients with severe CAP not meeting the
predictive findings in the prospective cohort (P = 0.003), although there only existed death of an uptrend in the retrospective cohort.
Two similar and intriguing paradigms about sequential organ failure assessment (SOFA)
scores and pneumonia severity index (PSI) scores were confirmed in the 2 cohorts.
Conclusions
The patients with non-severe CAP fulfilling the predictive findings most strongly
associated to mortality demonstrated higher SOFA and PSI scores and mortality rates,
and might have the priority for treatment and intensive care.
Keywords
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Article info
Publication history
Published online: August 07, 2018
Accepted:
August 1,
2018
Received:
December 22,
2017
Footnotes
Funding: This study was funded by the medical science and technology foundation of Guangdong province in 2010 (No. A2010553), the planned science and technology project of Shenzhen municipality in 2011 (No. 201102078) and the nonprofit scientific research project of Futian district in 2011 (No. FTWS201120).
Disclosures: All authors report no conflict of interest.
Identification
Copyright
© 2018 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.
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Access this article on ScienceDirectLinked Article
- Notice of Overlapping Publication: Priority for Treatment and Intensive Care of Patients With Nonsevere Community-Acquired Pneumonia [Li et al. Am J Med Sci, 2018; 356(4):329]The American Journal of the Medical SciencesVol. 358Issue 2
- PreviewThe Editorial Office wishes to disclose overlapping publications. In the October 2018 issue of The American Journal of the Medical Sciences, we published “Priority for Treatment and Intensive Care of Patients With Non-Severe Community-Acquired Pneumonia” by Li et al. The database used in this manuscript overlapped or partly overlapped with databases used in other published articles including Li et al. Am J Med Sci, 2015, 350(3): 186; Li et al. Medicine, 2015, 94(36):e1474; Guo et al. Respir Res, 2019, 20(1):22; and Guo et al.
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- Putting the CAP on ICU Admissions: Can Clinical Prediction Tools Help Determine Appropriate Site of Care?The American Journal of the Medical SciencesVol. 356Issue 4
- PreviewCommunity-acquired pneumonia (CAP) is the most common cause of infectious disease related mortality and a major burden to hospital and intensive care unit (ICU) resources.1 Clinical prediction rules such as the Pneumonia Severity Index (PSI) and CURB-65 have been developed to assess severity of illness to help determine the appropriate site of treatment and potentially avoid overutilization of these finite resources.2 Patients with PSI Class IV-V and CURB-65 scores 2-5 have a predicted mortality of 8.2% and 9.2%, respectively.
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