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Kudo M, Sasaki S, Takada T, Fujii K, Yagi Y, Yano T, Sada K, Fukuhara S, Suganuma N. Predicting 30-day mortality in older patients with suspected infections by adding performance status to quick sequential organ failure assessment. J Gen Fam Med 2025; 26:238-245. [PMID: 40291055 PMCID: PMC12022432 DOI: 10.1002/jgf2.764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Revised: 10/12/2024] [Accepted: 12/17/2024] [Indexed: 04/30/2025] Open
Abstract
Background Quick Sequential Organ Failure Assessment (qSOFA) is a simple and easy tool for identifying patients with suspected infection, who are at a high risk of poor outcome. However, its predictive performance is still insufficient. The Eastern Cooperative Oncology Group Performance Status (ECOG-PS) score, a tool to evaluate physical function, has been recently reported to be useful in predicting the prognosis of patients with pneumonia. We aimed to evaluate the added value of ECOG-PS to qSOFA in predicting 30-day mortality in older patients admitted with suspected infections. Methods Between 2018 and 2019, we prospectively collected data from adults aged 65 years or older, admitted with suspected infection at two acute care hospitals. Predictive performance was compared between two logistic regression models: one using qSOFA score alone (qSOFA model) and the other in which ECOG-PS was added to qSOFA (extended model). Results Of the 1536 enrolled patients, 135 (8.8%) died within 30 days. The area under the curve of the extended model was significantly higher than that of the qSOFA model (0.67 vs. 0.64, p = 0.008). When the risk groups were categorized as follows: low (<5%), intermediate (5%-10%), and high (≥10%), 5.0% of those who died and 2.1% of those who survived were correctly reclassified by the extended model with an overall categorized net reclassification improvement of 0.03 (95% confidence interval: -0.06 to 0.30). Conclusions Adding the ECOG-PS score could improve the performance of qSOFA in predicting mortality in older patients admitted with suspected infection.
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Affiliation(s)
- Masataka Kudo
- Department of General Internal MedicineIizuka HospitalFukuokaJapan
- Department of Clinical EpidemiologyKochi Medical SchoolNankokuJapan
- Department of Internal MedicineInan HospitalKochiJapan
| | - Sho Sasaki
- Section of Education for Clinical ResearchKyoto University HospitalKyotoJapan
- Clinical Research Support OfficeIizuka HospitalFukuokaJapan
| | - Toshihiko Takada
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR)Fukushima Medical UniversityFukushimaJapan
| | - Kotaro Fujii
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR)Fukushima Medical UniversityFukushimaJapan
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of MedicineKyoto UniversityKyotoJapan
- Academic and Research CentreHokkaido Centre for Family MedicineSapporoJapan
| | - Yu Yagi
- Department of General Internal MedicineIizuka HospitalFukuokaJapan
| | - Tetsuhiro Yano
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR)Fukushima Medical UniversityFukushimaJapan
| | - Ken‐ei Sada
- Department of Clinical EpidemiologyKochi Medical SchoolNankokuJapan
| | - Shunichi Fukuhara
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of MedicineKyoto UniversityKyotoJapan
| | - Narufumi Suganuma
- Medical School, Medical Course, Department of Human Health and Medical SciencesKochi Medical SchoolNankokuJapan
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Li S, Li L, Wang S, Wu H. Clinical characteristics and risk factors of hospital mortality in elderly patients with community-acquired pneumonia. Front Med (Lausanne) 2025; 12:1512288. [PMID: 40177286 PMCID: PMC11961441 DOI: 10.3389/fmed.2025.1512288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2024] [Accepted: 02/24/2025] [Indexed: 04/05/2025] Open
Abstract
Background Community-acquired pneumonia (CAP) leads to high morbidity and mortality among the elderly, with 3 million deaths annually worldwide. Multiple comorbidities significantly increase the risk. This study aims to identify independent risk factors for mortality in elderly patients with CAP to optimize individualized treatment strategies. Methods This single-center retrospective study was conducted at First Affiliated Hospital of Xi'an Medical University. Clinical data from elderly patients diagnosed with CAP between December 2018 and December 2023 were retrospectively collected. Logistic regression analysis was used to determine risk factors for in-hospital mortality. A nomogram was constructed based on the final model for risk assessment. Results A total of 613 eligible patients were included, with 68.2% being male, and a median age of 78 (IQR 70-86) years. The prevalence of hypertension, coronary heart disease (CHD), stroke, diabetes, malignancy, and chronic obstructive pulmonary disease (COPD) was 55.5, 39.8, 29.5, 27, 16.6, and 7%, respectively. The in-hospital mortality rate was 48%. Compared to survivors, non-survivors were older, had a higher proportion of males, faster heart rates, and higher rates of comorbidities. Multivariate logistic regression analysis identified age (OR 1.05, 95% CI [1.02-1.07], P < 0.01), BMI (OR 0.92, 95% CI [0.86-0.98], P < 0.01), stroke (OR 2.21, 95% [1.43-3.42], P < 0.01), ARDS (OR 4.0, 95% CI [2.17-7.37], P < 0.01), AKI (OR 2.98, 95% CI [1.77-5.01], P < 0.01), malignancy (OR 2.11, 95% CI [1.22-3.65], P < 0.01), elevated WBC (OR 1.20, 95% [1.14-1.27], P < 0.01), PLT (OR 0.995, 95% CI [0.993-0.998], P < 0.01), and albumin (OR 0.93, 95% CI [0.90-0.97], P < 0.01) as independent risk factors for in-hospital mortality. The area under the curve (AUC) of the multivariable model was 0.85 (95% CI [0.81-0.87], P < 0.01). Conclusion Elderly CAP patients have a high prevalence of comorbidities and a high in-hospital mortality rate. Advanced age, low BMI, stroke, ARDS, AKI, malignancy, elevated WBC, decreased PLT, and low albumin were independent risk factors for in-hospital mortality.
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Affiliation(s)
- Shasha Li
- Department of Nephrology, First Affiliated Hospital of Xi’an Medical University, Xi’an, Shaanxi, China
| | - Lu Li
- Department of Nephrology, First Affiliated Hospital of Xi’an Medical University, Xi’an, Shaanxi, China
| | - Shengyu Wang
- Department of Respiratory, First Affiliated Hospital of Xi’an Medical University, Xi’an, Shaanxi, China
| | - Hao Wu
- Department of Nephrology, First Affiliated Hospital of Xi’an Medical University, Xi’an, Shaanxi, China
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Miao L, Gong C, Liao J, Xie C, Shen X, Cheng Y. Dynamic Trends of Albumin-to-C-Reactive Protein Ratio: A Prognostic Indicator in Elderly Patients with Community-Acquired Pneumonia. J Inflamm Res 2025; 18:4195-4211. [PMID: 40125077 PMCID: PMC11930240 DOI: 10.2147/jir.s512632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2025] [Accepted: 03/14/2025] [Indexed: 03/25/2025] Open
Abstract
Background The prognostic significance of dynamic changes in the albumin-to-C-reactive protein ratio (ACR) in elderly patients with community-acquired pneumonia (CAP) has not been fully elucidated. This study aims to evaluate the utility of ACR as a dynamic biomarker for predicting 28-day mortality and enhancing risk stratification in this high-risk population. Methods A retrospective cohort study was conducted on 437 elderly CAP patients (≥65 years). Serum albumin and C-reactive protein (CRP) levels were measured at admission (T0), 24 hours (T1), and 3 days (T2) post-admission. ACR was calculated for each time point, and its prognostic value was assessed using advanced statistical methods. Results The 28-day mortality rate was 16.7%. ACR levels were consistently lower in non-survivors across all time points (P < 0.001). RCS analysis revealed a nonlinear relationship between ACR and mortality risk. Time-varying ROC analysis demonstrated that ACR consistently outperformed CRP in predicting mortality, with superior area under the curve (AUC) values at all time points. Random-effects modeling indicated minimal inter-individual variability in ACR (random effects variance: 0.030; standard deviation: 0.175). Time-varying Cox regression confirmed a strong negative association between dynamic ACR changes and mortality risk, with a C-statistic of 0.833 (P < 0.001). Conclusion Dynamic monitoring of ACR is a robust and clinically applicable tool for predicting short-term mortality in elderly CAP patients. By integrating markers of inflammation and nutritional status, ACR facilitates early identification of high-risk patients and supports personalized treatment strategies. These findings highlight the potential of ACR as a novel biomarker for improving clinical outcomes in this vulnerable population.
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Affiliation(s)
- Lei Miao
- Department of Critical Care Medicine, The second People’s Hospital of Lianyungang, Lianyungang, 222000, People’s Republic of China
| | - Chen Gong
- Department of Geriatrics, The second People’s Hospital of Lianyungang, Lianyungang, 222000, People’s Republic of China
| | - Jingxian Liao
- Department of Geriatrics, The second People’s Hospital of Lianyungang, Lianyungang, 222000, People’s Republic of China
| | - Chunhui Xie
- Department of Geriatrics, The second People’s Hospital of Lianyungang, Lianyungang, 222000, People’s Republic of China
| | - Xiaozhu Shen
- Department of Geriatrics, The second People’s Hospital of Lianyungang, Lianyungang, 222000, People’s Republic of China
| | - Yajuan Cheng
- Department of Critical Care Medicine, The second People’s Hospital of Lianyungang, Lianyungang, 222000, People’s Republic of China
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Abe S, Wannigama DL. Quick Sequential Organ Failure Assessment (qSOFA) and Performance Status Scoring Systems as Prognostic Predictors in Pneumococcal Community-Acquired Pneumonia. Cureus 2024; 16:e73201. [PMID: 39651035 PMCID: PMC11624957 DOI: 10.7759/cureus.73201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2024] [Indexed: 12/11/2024] Open
Abstract
Background and aim Streptococcus pneumoniae, or pneumococcus, is one of the most common pathogens responsible for community-acquired pneumonia (CAP), which can progress to sepsis and lead to severe illness. Several clinical scoring systems are widely used to assess the severity of CAP and sepsis. This study aims to evaluate the clinical factors that predict mortality in pneumococcal CAP (pCAP). Methods Patients eligible for this study were 16 years or older and diagnosed with pCAP at Yamagata Prefectural Central Hospital, Yamagata, Japan, between January 2012 and May 2018. pCAP was defined by the single isolation of S. pneumoniae from sputum or blood culture in patients with CAP. Patients were divided into two groups based on 60-day mortality: survivors and non-survivors. Clinical parameters, including performance status (PS), were assessed for both groups. Disease severity was evaluated using the A-DROP, CURB-65, and quick Sequential Organ Failure Assessment (qSOFA) scores. Statistical analysis was performed using JMP 11 software (JMP Statistical Discovery LLC, NC, USA). Results A total of 192 patients (135 men and 57 women) were enrolled in this study. The median age was 77 years (range: 21-97 years). Among them, 169 patients were survivors and 22 were non-survivors. S. pneumoniae was more frequently detected in the blood cultures of non-survivors than survivors (27.3% vs. 7.7%, respectively; p = 0.01, chi-square test). Non-survivors exhibited poorer PS (PS ≥3), higher A-DROP scores (A-DROP ≥3), and higher qSOFA scores (qSOFA ≥2) compared to survivors (p = 0.002, 0.02, and 0.0003, chi-square test, respectively). However, there was no significant difference in the CURB-65 score between the two groups. Multivariate analysis revealed that higher qSOFA scores and poor PS were independent risk factors for 60-day mortality in pCAP (OR 4.0 (95% CI: 1.3-13.3) and 4.0 (1.4-10.9), respectively). Conclusions The qSOFA and PS scoring systems may be useful in predicting the prognosis of pCAP.
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Affiliation(s)
- Shuichi Abe
- Department of Infectious Diseases and Infection Control, Yamagata Prefectural Central Hospital, Yamagata, JPN
| | - Dhammika Leshan Wannigama
- Department of Infectious Diseases and Infection Control, Yamagata Prefectural Central Hospital, Yamagata, JPN
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Development and validation of a new scoring system for prognostic prediction of community-acquired pneumonia in older adults. Sci Rep 2021; 11:23878. [PMID: 34903833 PMCID: PMC8668907 DOI: 10.1038/s41598-021-03440-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/30/2021] [Indexed: 01/22/2023] Open
Abstract
The discriminative power of CURB-65 for mortality in community-acquired pneumonia (CAP) is suspected to decrease with age. However, a useful prognostic prediction model for older patients with CAP has not been established. This study aimed to develop and validate a new scoring system for predicting mortality in older patients with CAP. We recruited two prospective cohorts including patients aged ≥ 65 years and hospitalized with CAP. In the derivation (n = 872) and validation cohorts (n = 1,158), the average age was 82.0 and 80.6 years and the 30-day mortality rate was 7.6% (n = 66) and 7.4% (n = 86), respectively. A new scoring system was developed based on factors associated with 30-day mortality, identified by multivariate analysis in the derivation cohort. This scoring system named CHUBA comprised five variables: confusion, hypoxemia (SpO2 ≤ 90% or PaO2 ≤ 60 mmHg), blood urea nitrogen ≥ 30 mg/dL, bedridden state, and serum albumin level ≤ 3.0 g/dL. With regard to 30-day mortality, the area under the receiver operating characteristic curve for CURB-65 and CHUBA was 0.672 (95% confidence interval, 0.607–0.732) and 0.809 (95% confidence interval, 0.751–0.856; P < 0.001), respectively. The effectiveness of CHUBA was statistically confirmed in the external validation cohort. In conclusion, a simpler novel scoring system, CHUBA, was established for predicting mortality in older patients with CAP.
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Seo H, Cha SI, Lee WK, Park JE, Choi SH, Lee YH, Yoo SS, Lee SY, Lee J, Kim CH, Park JY. Prognostic factors in patients hospitalized with community-acquired aspiration pneumonia. J Infect Chemother 2021; 28:47-53. [PMID: 34627705 DOI: 10.1016/j.jiac.2021.09.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/12/2021] [Accepted: 09/28/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Patients with aspiration pneumonia (AP) exhibit higher mortality than those with non-AP. However, data regarding predictors of short-term prognosis in patients with community-acquired AP are limited. METHODS Patients hospitalized with community-acquired pneumonia (CAP) were retrospectively classified into aspiration pneumonia (AP) and non-AP groups. The AP patients were further divided into nonsurvivors and survivors by 30-day mortality, and various clinical variables were compared between the groups. RESULTS Of 1249 CAP patients, 254 (20.3%) were classified into the AP group, of whom 76 patients (29.9%) died within 30 days. CURB-65, pneumonia severity index (PSI), and Infectious Diseases Society of America/American Thoracic Society criteria for severe CAP (SCAP) showed only modest prognostic performance for the prediction of 30-day mortality (c-statistics, 0.635, 0.647, and 0.681, respectively). Along with the PSI and SCAP, Eastern Cooperative Oncology Group performance status (ECOG-PS) and blood biomarkers, including, N-terminal of prohormone brain natriuretic peptide (NT-proBNP) and albumin, were independent predictors of 30-day mortality. In models based on clinical prediction rules, including CURB-65, PSI, and SCAP, the addition of ECOG-PS further improved their c-statistics compared to the clinical prediction rules alone. In the four combinations based on SCAP, ECOG-PS, and two blood biomarkers (NT-proBNP and albumin), the c-statistics further increased to reach approximately 0.8. CONCLUSIONS CURB-65, PSI, and SCAP exhibited only modest discriminatory power in predicting the 30-day mortality of patients with community-acquired AP. The addition of performance status and blood biomarkers, including NT-proBNP and albumin, further increased prognostic performance, showing good predictive accuracy in the SCAP-based model.
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Affiliation(s)
- Hyewon Seo
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Seung-Ick Cha
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
| | - Won Kee Lee
- Biostatistics, Medical Research Collaboration Center, Kyungpook National University, Daegu, Republic of Korea
| | - Ji-Eun Park
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Sun Ha Choi
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Yong-Hoon Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Seung-Soo Yoo
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Shin-Yup Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jaehee Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Chang-Ho Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jae-Yong Park
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
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Quah J, Liew CJY, Zou L, Koh XH, Alsuwaigh R, Narayan V, Lu TY, Ngoh C, Wang Z, Koh JZ, Ang C, Fu Z, Goh HL. Chest radiograph-based artificial intelligence predictive model for mortality in community-acquired pneumonia. BMJ Open Respir Res 2021; 8:8/1/e001045. [PMID: 34376402 PMCID: PMC8354266 DOI: 10.1136/bmjresp-2021-001045] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 07/21/2021] [Indexed: 12/15/2022] Open
Abstract
Background Chest radiograph (CXR) is a basic diagnostic test in community-acquired pneumonia (CAP) with prognostic value. We developed a CXR-based artificial intelligence (AI) model (CAP AI predictive Engine: CAPE) and prospectively evaluated its discrimination for 30-day mortality. Methods Deep-learning model using convolutional neural network (CNN) was trained with a retrospective cohort of 2235 CXRs from 1966 unique adult patients admitted for CAP from 1 January 2019 to 31 December 2019. A single-centre prospective cohort between 11 May 2020 and 15 June 2020 was analysed for model performance. CAPE mortality risk score based on CNN analysis of the first CXR performed for CAP was used to determine the area under the receiver operating characteristic curve (AUC) for 30-day mortality. Results 315 inpatient episodes for CAP occurred, with 30-day mortality of 19.4% (n=61/315). Non-survivors were older than survivors (mean (SD)age, 80.4 (10.3) vs 69.2 (18.7)); more likely to have dementia (n=27/61 vs n=58/254) and malignancies (n=16/61 vs n=18/254); demonstrate higher serum C reactive protein (mean (SD), 109 mg/L (98.6) vs 59.3 mg/L (69.7)) and serum procalcitonin (mean (SD), 11.3 (27.8) μg/L vs 1.4 (5.9) μg/L). The AUC for CAPE mortality risk score for 30-day mortality was 0.79 (95% CI 0.73 to 0.85, p<0.001); Pneumonia Severity Index (PSI) 0.80 (95% CI 0.74 to 0.86, p<0.001); Confusion of new onset, blood Urea nitrogen, Respiratory rate, Blood pressure, 65 (CURB-65) score 0.76 (95% CI 0.70 to 0.81, p<0.001), respectively. CAPE combined with CURB-65 model has an AUC of 0.83 (95% CI 0.77 to 0.88, p<0.001). The best performing model was CAPE incorporated with PSI, with an AUC of 0.84 (95% CI 0.79 to 0.89, p<0.001). Conclusion CXR-based CAPE mortality risk score was comparable to traditional pneumonia severity scores and improved its discrimination when combined.
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Affiliation(s)
- Jessica Quah
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
| | | | - Lin Zou
- Integrated Health Information Systems Pte Ltd, Singapore
| | - Xuan Han Koh
- Health Services Research, Changi General Hospital, Singapore
| | - Rayan Alsuwaigh
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
| | | | - Tian Yi Lu
- Integrated Health Information Systems Pte Ltd, Singapore
| | - Clarence Ngoh
- Integrated Health Information Systems Pte Ltd, Singapore
| | - Zhiyu Wang
- Integrated Health Information Systems Pte Ltd, Singapore
| | - Juan Zhen Koh
- Integrated Health Information Systems Pte Ltd, Singapore
| | - Christine Ang
- Integrated Health Information Systems Pte Ltd, Singapore
| | - Zhiyan Fu
- Integrated Health Information Systems Pte Ltd, Singapore
| | - Han Leong Goh
- Integrated Health Information Systems Pte Ltd, Singapore
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Ewig S, Kolditz M, Pletz M, Altiner A, Albrich W, Drömann D, Flick H, Gatermann S, Krüger S, Nehls W, Panning M, Rademacher J, Rohde G, Rupp J, Schaaf B, Heppner HJ, Krause R, Ott S, Welte T, Witzenrath M. [Management of Adult Community-Acquired Pneumonia and Prevention - Update 2021 - Guideline of the German Respiratory Society (DGP), the Paul-Ehrlich-Society for Chemotherapy (PEG), the German Society for Infectious Diseases (DGI), the German Society of Medical Intensive Care and Emergency Medicine (DGIIN), the German Viological Society (DGV), the Competence Network CAPNETZ, the German College of General Practitioneers and Family Physicians (DEGAM), the German Society for Geriatric Medicine (DGG), the German Palliative Society (DGP), the Austrian Society of Pneumology Society (ÖGP), the Austrian Society for Infectious and Tropical Diseases (ÖGIT), the Swiss Respiratory Society (SGP) and the Swiss Society for Infectious Diseases Society (SSI)]. Pneumologie 2021; 75:665-729. [PMID: 34198346 DOI: 10.1055/a-1497-0693] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The present guideline provides a new and updated concept of the management of adult patients with community-acquired pneumonia. It replaces the previous guideline dating from 2016.The guideline was worked out and agreed on following the standards of methodology of a S3-guideline. This includes a systematic literature search and grading, a structured discussion of recommendations supported by the literature as well as the declaration and assessment of potential conflicts of interests.The guideline has a focus on specific clinical circumstances, an update on severity assessment, and includes recommendations for an individualized selection of antimicrobial treatment.The recommendations aim at the same time at a structured assessment of risk for adverse outcome as well as an early determination of treatment goals in order to reduce mortality in patients with curative treatment goal and to provide palliation for patients with treatment restrictions.
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Affiliation(s)
- S Ewig
- Thoraxzentrum Ruhrgebiet, Kliniken für Pneumologie und Infektiologie, EVK Herne und Augusta-Kranken-Anstalt Bochum
| | - M Kolditz
- Universitätsklinikum Carl-Gustav Carus, Klinik für Innere Medizin 1, Bereich Pneumologie, Dresden
| | - M Pletz
- Universitätsklinikum Jena, Institut für Infektionsmedizin und Krankenhaushygiene, Jena
| | - A Altiner
- Universitätsmedizin Rostock, Institut für Allgemeinmedizin, Rostock
| | - W Albrich
- Kantonsspital St. Gallen, Klinik für Infektiologie/Spitalhygiene
| | - D Drömann
- Universitätsklinikum Schleswig-Holstein, Medizinische Klinik III - Pulmologie, Lübeck
| | - H Flick
- Medizinische Universität Graz, Universitätsklinik für Innere Medizin, Klinische Abteilung für Lungenkrankheiten, Graz
| | - S Gatermann
- Ruhr Universität Bochum, Abteilung für Medizinische Mikrobiologie, Bochum
| | - S Krüger
- Kaiserswerther Diakonie, Florence Nightingale Krankenhaus, Klinik für Pneumologie, Kardiologie und internistische Intensivmedizin, Düsseldorf
| | - W Nehls
- Helios Klinikum Erich von Behring, Klinik für Palliativmedizin und Geriatrie, Berlin
| | - M Panning
- Universitätsklinikum Freiburg, Department für Medizinische Mikrobiologie und Hygiene, Freiburg
| | - J Rademacher
- Medizinische Hochschule Hannover, Klinik für Pneumologie, Hannover
| | - G Rohde
- Universitätsklinikum Frankfurt, Medizinische Klinik I, Pneumologie und Allergologie, Frankfurt/Main
| | - J Rupp
- Universitätsklinikum Schleswig-Holstein, Klinik für Infektiologie und Mikrobiologie, Lübeck
| | - B Schaaf
- Klinikum Dortmund, Klinik für Pneumologie, Infektiologie und internistische Intensivmedizin, Dortmund
| | - H-J Heppner
- Lehrstuhl Geriatrie Universität Witten/Herdecke, Helios Klinikum Schwelm, Klinik für Geriatrie, Schwelm
| | - R Krause
- Medizinische Universität Graz, Universitätsklinik für Innere Medizin, Klinische Abteilung für Infektiologie, Graz
| | - S Ott
- St. Claraspital Basel, Pneumologie, Basel, und Universitätsklinik für Pneumologie, Universitätsspital Bern (Inselspital) und Universität Bern
| | - T Welte
- Medizinische Hochschule Hannover, Klinik für Pneumologie, Hannover
| | - M Witzenrath
- Charité, Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Infektiologie und Pneumologie, Berlin
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Lopez Cuenca S, Oteiza L, Lazaro Martín N, Ibarz M, Irazabal M, Artigas A, Lorente JA. [ISAR Score (Identification of Seniors At Risk) predicts mortality in patients older than 75 years admitted in Intensive Care]. Rev Esp Geriatr Gerontol 2020; 56:5-10. [PMID: 33309421 DOI: 10.1016/j.regg.2020.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/16/2020] [Accepted: 09/25/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Currently, the patient's baseline situation is a more important prognostic factor than age. The purpose of this study is to estimate the prognostic value of the ISAR score (Identification of Senior at Risk) in patients ≥75 years admitted to intensive care (ICU). PATIENTS AND METHODS Prospective multicenter study including patients ≥75 years admitted to the ICU > 24hours. On admission, 28 days and 6 months after discharge from the ICU, mortality and baseline were evaluated using the ISAR score, the Lawton and Brody scale (LB) and the Barthel index (BI), the Frail fragility scale. scale (FS), the Charlson comorbidity index (ICC), Dementia rating score (DRC). RESULTS 38 of 94 patients (40%) were high risk (ISAR ≥ 3) and were characterized by BI 90 (65-100), LB 4 (3-5), and CDR 1 (0-2), ICC 7.5 (6-10). 58% had FS ≥ 3. In the long term, they were in a situation of dependency [BI 50 (2.5-77.5), LB 3 (0-4), CDR 1 (0-1.5)]. The ICU mortality at 28 days and 6 months was 18.4%, 25.7% and 35.3%, respectively, being statistically significant. The area under the ISAR score ROC curve was 0.749 to 0.797, in all the mortality periods studied, although the difference with other predictive variables was not significant, but the p value was the lowest. CONCLUSIONS The ISAR score predicts mortality in critically elderly patients with a discriminative capacity comparable to other predictive variables.
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Affiliation(s)
- Sonia Lopez Cuenca
- Servicio de Medicina Intensiva y Grandes Quemados, Hospital Universitario de Getafe, Getafe, Madrid, España.
| | - Lorena Oteiza
- Servicio de Medicina Intensiva y Grandes Quemados, Hospital Universitario de Getafe, Getafe, Madrid, España
| | - Noelia Lazaro Martín
- Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España
| | - Mercedes Ibarz
- Servicio de Medicina Intensiva, Hospital Universitario Sagrat Cor, Barcelona, España
| | - Marian Irazabal
- Servicio de Medicina Intensiva, Hospital Universitario General de Cataluña, Barcelona, España
| | - Antonio Artigas
- Corporación Universitaria Parc Taulí, CIBER de Enfermedades Respiratorias, Universidad Autónoma de Barcelona, Sabadell, Barcelona, España; Departamento de Medicina Intensiva, Hospitales Universitarios Sagrado Corazón, General de Cataluña, Quirón Salud, Barcelona-San Cugat del Vallès, España
| | - José A Lorente
- Servicio de Medicina Intensiva y Grandes Quemados, Hospital Universitario de Getafe, Getafe, Madrid, España; CIBER de Enfermedades Respiratorias, Madrid, Universidad Europea, Madrid, España
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10
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Factors associated with lethality from pneumonia in an acute care for the elderly unit: a retrospective cohort. BIOMEDICA 2020; 40:734-748. [PMID: 33275351 PMCID: PMC7808781 DOI: 10.7705/biomedica.5244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Indexed: 11/21/2022]
Abstract
Introduction: Pneumonia is the leading cause of death due to infection in the world, mainly affecting the older adult population.
Objective: To determine the risk factors associated with lethality at 30 days in patients with pneumonia in an acute care for the elderly unit.
Materials and methods: We conducted an observational, analytical retrospective cohort study including 114 patients aged 60 years and older hospitalized in an acute care geriatric unit with a diagnosis of pneumonia. The primary outcome was lethality at 30 days.
Bivariate and multivariable log-binomial regression analyzes were performed to explore the relationship between independent variables and the primary outcome.
Results: The 30-day lethality was 26.3% and the mean age was 84.45 ± 7.37 years; 54.4% of participants were men. In the multivariable analysis, age ≥90 years (Relative Risk, RR=1.62, 95% CI: 1.05-2.68, p=0.04), multilobar commitment (RR=1.92, 95% CI:1.12-3.32, p=0.02), elevated urea nitrogen (≥22.5 the median; RR=3.93, 95% CI:1.67-9.25, p<0.01), and a score of zero in the Lawton index at admission (RR=3.20, 95% CI:1.05-9.78, p=0.04) were independent predictors of 30-day lethality from pneumonia.
Conclusion: In older adults hospitalized for pneumonia in an acute care geriatric unit, advanced age, the presence of multilobar commitment, dependency in functional status, and elevated ureic nitrogen levels were the main predictors of short-term lethality risk.
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Simcock R, Wright J. Beyond Performance Status. Clin Oncol (R Coll Radiol) 2020; 32:553-561. [PMID: 32684503 PMCID: PMC7365102 DOI: 10.1016/j.clon.2020.06.016] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 06/19/2020] [Accepted: 06/25/2020] [Indexed: 12/13/2022]
Abstract
Oncologists should recognise the need to move beyond the Eastern Cooperative Oncology Group Performance Status (ECOG PS) score. ECOG PS is a longstanding and ubiquitous feature of oncology. It was evolved 40 years ago as an adaption of the 70-year-old Karnofsky performance score. It is short, easily understood and part of the global language of oncology. The wide prevalence of the ECOG PS attests to its proven utility and worth to help triage patient treatment. The ECOG PS is problematic. It is a unidimensional functional score. It is mostly physician assessed, subjective and therefore open to bias. It fails to account for multimorbidity, frailty or cognition. Too often the PS is recorded only once in wilful ignorance of a patient's changing physical state. As modern oncology offers an ever-widening array of therapies that are ‘personalised’ to tumour genotype, modern oncologists must strive to better define patient phenotype. Using a wider range of scoring and assessment tools, oncologists can identify deficits that may be reversed or steps taken to mitigate detrimental effects of treatment. These tools can function well to identify those patients who would benefit from comprehensive assessment. This overview identifies the strengths of ECOG PS but highlights the weaknesses and where these are supported by other measures. A strong recommendation is made here to move to routine use of the Clinical Frailty Score to start to triage patients and most appropriately design treatments and rehabilitation interventions.
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Affiliation(s)
- R Simcock
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
| | - J Wright
- Brighton and Sussex Medical School, Brighton, UK
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12
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Cillóniz C, Rodríguez-Hurtado D, Torres A. Characteristics and Management of Community-Acquired Pneumonia in the Era of Global Aging. Med Sci (Basel) 2018; 6:medsci6020035. [PMID: 29710871 PMCID: PMC6024853 DOI: 10.3390/medsci6020035] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 04/25/2018] [Accepted: 04/26/2018] [Indexed: 12/30/2022] Open
Abstract
Community-acquired pneumonia (CAP) can occur at any time of life, but its incidence and risk of death are linked to increasing age. CAP in the elderly is a major health problem associated with high rates of readmission, morbidity, and mortality. Since the clinical presentation of pneumonia in the elderly may be atypical, clinicians should suspect pneumonia in older patients presenting symptoms such as falls and altered mental status, fatigue, lethargy, delirium, anorexia, in order to avoid the complications associated with delayed diagnosis and therapy. Streptococcus pneumoniae remains the most frequently reported pathogen in this population. However, particular attention should be paid to patients with risk factors for multidrug resistant pathogens, because a large proportion of elderly persons present multimorbidity. Vaccination is one of the most important preventive approaches for CAP in the elderly. In addition, lifestyle-tailored interventions for different modifiable risk factors will help to reduce the risk of pneumonia in elderly persons. Surveillance of etiological pathogens may improve vaccination policies in this population.
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Affiliation(s)
- Catia Cillóniz
- Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona - SGR 911- Ciber de Enfermedades Respiratorias (Ciberes) Barcelona 08036, Spain.
| | - Diana Rodríguez-Hurtado
- Full Professor School of Medicine Universidad Peruana Cayetano Heredia. Department of Medicine, "Hospital Nacional Arzobispo Loayza", Lima 15082, Peru.
| | - Antoni Torres
- Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona - SGR 911- Ciber de Enfermedades Respiratorias (Ciberes) Barcelona 08036, Spain.
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