Etiological profile, prescribing pattern of antibiotics and clinical outcomes of pneumonia patients in a tertiary care hospital in South India during 5-year period

Background: Pneumonia is one of the most important and serious lower respiratory tract infections, which requires implacable attention. This work aimed to document the causative organisms, antibiotics used, and outcome of pneumonia patients hospitalized in a tertiary care hospital. Materials and Methods: A retrospective study was conducted in the medical departments of a tertiary care teaching hospital for 5 years. Demographic details and clinical details including pertinent laboratory values of patients diagnosed with pneumonia were documented and analyzed using a specifically designed data collection form. Results: The study was conducted on 190 patients. The average age of the study population was 56.7 ± 22.6 years and there was a male preponderance of 111(58.4%) patients. Klebsiella pneumonia was found to be the most frequently isolated pathogen in 12.5% of the sputum culture, followed by Acinetobacter baumannii in 10.22% and Pseudomonas aeruginosa in 9.09%. The most commonly prescribed empirical antibiotics were beta-lactam antibiotics mostly in combination with macrolides for synergy irrespective of Pneumonia Severity Index (PSI) classes. Definitive therapy was classified based on World Health Organization (WHO) Access, Watch, and Reserve (AWaRe) classification of antibiotics, watch category antibiotics were prescribed according to culture report and reserve antibiotics were prescribed only in those cases where watch category antibiotics were resistant. On analyzing PSI of community-acquired pneumonia (176 patients), most of the patients in the study belong to class 4: 61 patients (34.7%) and class 5: 44 patients (25%). For the high-risk patients (PSI class 4 and 5), mortality was approximately 3.8% (4 of 105) and for low-risk patients, there was zero mortality reported within 30 days. Conclusion: Gram-negative bacteria were the major pathogens causing Pneumonia in the study site contradictory to the data from developed countries. Identifications of pathogens and appropriate antibiotic therapy based on PSI score can bring down the duration of hospital stay and mortality of patients with pneumonia.

Clinical Profile of Community Acquired Pneumonia (CAP) in Patients with Type 2 Diabetes Mellitus - A Hospital Based Study

It is well known fact that diabetics are prone to develop infections and have increased mortality and morbidity than non-diabetics. However, the effect of diabetes mellitus on the risk of pneumonia remains uncertain. We wanted to study the aetiology, clinical features, and the outcome of pneumonia in diabetic patients. METHODSA comparative observational study was conducted in a tertiary care hospital, southern India which included 50 diabetic patients with pneumonia and 50 non-diabetic patients with pneumonia. Clinical characteristics, x-ray findings, aetiological agents, and outcome of diabetic patients were analysed and compared with data from the control group. RESULTSDiabetic patients with pneumonia were more unwell at the time of admission in the form of high PSI (Pneumonia Severity Index) score (p = 0.004**), intensive care admissions and prolonged hospital stay (p = < 0.001**). Diabetic patients were significantly associated with multilobar involvement (p = 0.045*). There was no significant difference in age, gender, coexisting underlying disease and complications. In patients with diabetes mellitus, mortality was associated with multilobar infiltrate, increased PSI score (p = 0.078*) at admission. CONCLUSIONSThese is a significant difference between pneumonia in diabetics compared with non-diabetics. Diabetic patients had presented with higher PSI score, required more ICU admissions and had prolonged hospitalization. Diabetes is also associated with bad prognosis and high mortality.

A comparative study of PSI and Curb-65 scoring systems in predicting ICU admissions and mortality in cases of community-acquired pneumonia

Background:Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality worldwide. Despite advanced diagnostic modalities and treatment options, CAP is the fourth leading cause of death in developing countries.Several severity scores have been proposed to guide initial decision making on hospitalization and to predict the outcome. Pneumonia Severity Index (PSI) and CURB 65 are the two most widely used scoring systems to prognosticate pneumonia. Aim: To compare the efficacy of PSI and CURB 65 scoring systems inprognosticating the ICU admission and outcome in cases of CAP. Methodology: This wasan observational study conducted at a tertiary care hospital in westernMaharashtra.A hundred patients of CAP fulfilling the inclusion criteria were enrolled in the study, classified as per CURB 65 and PSI system and their outcome compared. Result: The study subjects comprised of 100 patients (64 men and 36 women) of CAP. Twenty-four patients needed ICU admission.In both PSI and CURB-65 risk scoring systems, the need for intensive care unit (ICU) admission and mortality rates increased progressively with increasing scores.PSI class ≥IV and CURB 65 ≥III had 77.52% and 40.24% sensitivity and 88.46% and 69.48% specificity respectively in predicting ICU admissions. The PSI class ≥IV had more sensitivity and specificity in predicting ICU admission than CURB-65.CURB 65 class III and IV had sensitivity86.59% and 89.64% and specificity 89.64% and 97.54% respectivelyin predicting mortality, while PSI class IV and Vhadsensitivity68.92% and 72.58% and specificity 24.74% and 54.86% respectively. CURB 65 had more sensitivity and specificity than PSI in predicting mortality. Conclusion: The PSI is better in predicting the need for ICU admission and CURB 65 is a better predictor of mortality in cases of community-acquired pneumonia.

Confusion, blood urea, respiration and blood pressure 65, pneumonia severity index and shock index and hypoxemia scores in community acquired pneumonia and outcome prediction: a descriptive study from Dr B R Ambedkar Memorial Hospital Raipur, India

Background: According to WHO, pneumonia is the third important cause of death worldwide despite various advances in medical science. Incidence of Community acquired pneumonia is about 20% to 30% in developing countries compared to 3% to 4 % in developed countries. Incidence of CAP is much higher in the very young and the elderly individuals. Objectives of the study was to compare CURB 65, PSI (Pneumonia severity index) and SIPF (shock index and hypoxemia) scores with respect to outcome prediction in community acquired pneumonia (CAP).Methods: The present hospital based descriptive observational study was conducted in the Dept of medicine, Pt. J.N.M. Medical College and Dr B. R. A. M. Hospital, Raipur, during 2016-2018 involving a total of 98 patients of community acquired pneumonia.Results: Majority of them i.e. 22 (22.4%) subjects belonged to age group 41-50 years. 34 (34.7%) subjects were found to have CURB65 score 1. 28(28.6%) subjects PSI score was noted to be class I. 89 (90.8%) subjects were discharged while, there was death of 9 (9.2%) subjects. The difference in the mean score was statistically significant (p<0.001). PSI score was found to have diagnostic sensitivity of 94.4% and specificity of 100% while CURB 65 score having 83.1% sensitivity and 100 % specificity. SIPF score had least AUC 0.88.Conclusions: Maximum diagnostic ability was noted with PSI score followed by CURB 65 and SIPF score.

Preliminary study on the value of the new community acquired pneumonia severity index / 中华急诊医学杂志

Objective To explore the value of a new community-acquired pneumonia severity index(CPSI) in predicting the severity and mortality of patients with community-acquired pneumonia(CAP).Methods A retrospective analysis was conducted.Patients with CAP in critical care medicine of the First People's Hospital of Chenzhou were enrolled in this study.According to whether the patients died within 28 days,patients were divided into the survival group and the death group.The difference of sex,age,vital signs,blood test,the lowest Glasgow coma score (GCS) and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score,sepsis related organ failure assessment (SOFA)score,CURB-65 (confusion,uremia,respiratory rate,BP,age 65 years) score,pneumonia severity index (PSI) score and community-acquired pneumonia severity index (CPSI) score were compared between the two groups.Logistic regression analysis was performed for the scoring systems with statistical significance in univariate analysis.The receiver operating characteristic (ROC) was drawn to analyze the prognostic value of each scoring system.Results Totally 283 patients were enrolled in this study (184 survivals and 99 deaths,mortality rate 35％).Univariate analysis showed that age,mechanical ventilation (MV) ratio,the fastest heart beat rate (HR),the lowest systolic blood pressure (SBP),the lowest mean blood pressure (MAP),pressure adjusted shock index (PASI),inspired oxygen concentration (FiO2),arterial oxygen partial pressure (PaO2),and oxygenation index (PO2/FiO2),blood urea nitrogen concentration (BUN),serum creatinine concentration (Scr),urine output,length of ICU stay,the lowest GCS,and APACHE Ⅱ score were significantly different between the two groups (P＜0.05).Multivariate regression analysis showed that CPSI score and SOFA score were independent risk factors for patients with CAP.The ROC curve of CAP patients was predicted in each scoring system,and the area under the ROC curve of CPSI score (0.728),SOFA and age score (0.708),PSI score (0.701),APACHE Ⅱ score (0.690),CURB-65 score (0.687) and SOFA score (0.683) gradually decreased.The sensitivity and specificity of the area under curve prediction showed that CPSI score was superior to the other scores.Conclusions The CPSI score can evaluate the severity of CAP patients,efficiently predict the outcome of patients with CAP,and can be widely used in clinical practice.

Prognostic factors for mortality due to pneumonia among adults from different age groups in Singapore and mortality predictions based on PSI and CURB-65

<p><b>INTRODUCTION</b>Pneumonia is associated with considerable mortality. However, there is limited information on age-specific prognostic factors for death from pneumonia.</p><p><b>METHODS</b>Patients hospitalised with a diagnosis of pneumonia through the emergency department were stratified into three age groups: 18-64 years, 65-84 years and ≥ 85 years. Multivariate logistic regression and receiver operating characteristic curve analyses were conducted to evaluate prognostic factors for mortality and the performance of pneumonia severity scoring tools for mortality prediction.</p><p><b>RESULTS</b>A total of 1,902 patients were enrolled (18-64 years: 614 [32.3%]; 65-84 years: 944 [49.6%]; ≥ 85 years: 344 [18.1%]). Mortality rates increased with age (18-64 years: 7.3%; 65-84 years: 16.1%; ≥ 85 years: 29.7%; p < 0.001). Malignancy and tachycardia were prognostic of mortality among patients aged 18-64 years. Male gender, malignancy, congestive heart failure and eight other parameters reflecting acute disease severity were associated with mortality among patients aged 65-84 years. For patients aged ≥ 85 years, altered mental status, tachycardia, blood urea nitrogen, hypoxaemia, arterial pH and pleural effusion were significantly predictive of mortality. The Pneumonia Severity Index (PSI) was more sensitive than CURB-65 (confusion, uraemia, respiratory rate ≥ 30 per minute, low blood pressure, age ≥ 65 years) for mortality prediction across all age groups.</p><p><b>CONCLUSION</b>The predictive effect of prognostic factors for mortality varied among patients with pneumonia from the different age groups. PSI performed significantly better than CURB-65 for mortality prediction, but its discriminative power decreased with advancing age.</p>

D-dimer can reflect severity of patients with community-acquired pneumonia and predict prognosis / 中华危重病急救医学

Objective To investigate the utility of plasma D-dimer and fibrinogen (FIB) for the severity assessments and predicting the prognosis of patients with community-acquired pneumonia (CAP).Methods The clinical data of patients with CAP admitted to First Affiliated Hospital of Fujian Medical University were retrospectively analyzed.The patients were divided into Ⅰ-Ⅴ level groups according to pneumonia severity index (PSI),and they were divided into non-survivors and survivors according to 30-day prognosis.The data including gender,age,PSI score,platelets count (PLT),white blood cell count (WBC),D-dimer,FIB,and C-reactive protein (CRP) were compared among groups.The correlations between PSI score and D-dimer,CRP as well as FIB were analyzed by Spearman or Pearson correlation analysis.Receiver operating characteristic curve (ROC) was used to assess the prognostic value of these indicators.Results A total of 499 patients with CAP were enrolled with 298 male and 201 female,the average age was (63.4 ± 17.8) years old,and the 30-day mortality was 6.4％ (32/499).There were 77,80,104,162 and 76 patients in PSI Ⅰ-Ⅴ level groups,and there were more male patients in PSI Ⅵ and Ⅴ level groups.There were no significant differences in PLT and FIB among the groups of different PSI levels,but the levels of WBC,D-dimer and CRP were significantly increased as PSI level increased from Ⅰ to Ⅴ (F1 =3.810,x 22 =102.361,F3 =7.070,all P ＜ 0.01).Compared with survivors,the non-survivors were elder (t =-4.773,P ＜ 0.001) with lower PLT (t =3.026,P =0.003)and higher WBC,PSI score,D-dimer and CRP levels (t1 =-2.545,t2 =-8.421,Z3 =-6.947,t4 =-3.770,all P ＜ 0.05).Plasma D-dimer levels in elderly patients (≥ 65 years old) were statistically higher than those in younger patients (＜ 65 years old;Z =-5.338,P ＜ 0.01).It was shown by correlation analysis that PSI score was positively correlated with D-dimer and CRP (r values were 0.475 and 0.260,both P ＜ 0.001),and no correlation was found between PSI score and FIB (r =-0.062,P =0.170).The area under the ROC curve (AUC) for predicting 30-day death of PSI score,D-dimer and CRP was 0.858 [95％ confidence interval (95％CI) =0.802-0.914],0.867 (95％CI =0.812-0.922) and 0.732 (95％CI =0.641-0.823).The combination of D-dimer and PSI score was better than any single indicator for predicting the prognosis with higher AUC up to 0.905 (95％CI =0.867-0.944),all P ＜ 0.001.The sensitivity and specificity for PSI in predicting 30-day death respectively were 78.1％ and 82.4％ with the cut-off of greater than 122,and those for D-dimer were 75.0％ and 82.9％ with the cut-off of greater than 2.10 mg/L,50.0％ and 84.4％ for CRP with the cut-off of greater than 100.50 mg/L.Conclusions D-dimer could well reflect the severity of CAP and be a good indicator for predicting the prognosis.The combination of D-dimer and PSI might improve the accuracy in predicting prognosis.

The value of application of coagulopathy in assessing patients with community-acquired pneumonia / 中华急诊医学杂志

Objective To explore and evaluate the predictive value of the coagulopathy in patients with community-acquired pneumonia (CAP).Methods A retrospective study was carried out for investigating the prothrombin time (PT),activated partial thromboplastin time (APTT),plasma fibrinogen (FIB),thrombin time (TT),plateslets (PLT),D-dimer in 385 patients with CAP and 146 patients without infection,tumor,trauma,thrombosis as controls.All the patients were admitted to the Respiratory Medical Department from June,2010 to May,2011.The results of the aforementioned biomarkers were analyzed and compared between two groups.The Pneumonia Severity Index (PSI) was calculated to evaluate the correlation between coagulopathy and PSI.Results The comparisons of the abnormal rates of PLT,PT,APTT,Fib,D-dimer between the patients with CAP and the controls were 92/385 vs.9/146,39/385 vs.1/146,108/385 vs.7/ 146,331/385 vs.47/146,348/385 vs.5/146,respectively.The differences were statistically significant (x2 =21.608,13.557,33.747,149.280,365.619,respectively,P ＜ 0.01),while difference in TT was not statistically significant (8/385 and 0/146,x2 =1.839,P ＞ 0.05).The differences in abnormal rate of PLT,PT,D-dimer between high-risk group of CAP and the low-risk group of CAP were 45/148 vs.47/237,26/148 vs.13/237,146/148vs.202/237,respectively,and the differences were statistically significant (x2 =5.602,14.609,23.442,respectively,P ＜0.05),while there were no differences in TT,APTT,FIB between two groups (6/148 vs.2/237,47/148 vs.61/237,123/148 vs.208/237,x2 =4.614,1.635,1.638,respectively,P ＞0.05).D-dimer in patients with CAP was (3.8 ±6.1) mg/L,compared with the controls (0.3 ±0.1) mg/L,and D-dimer in high-risk patients with CAP was (7.5 ±8.3) mg/L compared with the low-risk group (1.6 ±2.0) mg/L (P ＜ 0.001).Rank correlation existed between D-dimer and PSI (r =0.798,P ＜ 0.01),while there was no correlation between PLT and PSI (x2 =6.040,P ＞0.05).Conclusions The coagulopathy commonly occurs in patients with CAP.D-dimer was significantly higher in patients with CAP.D-dimer level is positively correlated with severity of CAP.D-dimer can be an ideal biomarker to assess the severity of patients with CAP.

B-type natriuretic peptide in predicting the severity of community-acquired pneumonia / 世界急诊医学杂志（英文）

@#BACKGROUND: Although pneumonia severity index (PSI) is widely used to evaluate the severity of community-acquired pneumonia (CAP), the calculation of PSI is very complicated. The present study aimed to evaluate the role of B-type natriuretic peptide (BNP) in predicting the severity of CAP. METHODS: For 202 patients with CAP admitted to the emergency department, BNP levels, cardiac load indexes, inflammatory indexes including C-reactive protein (CRP), white blood cell count (WBC), and PSI were detected. The correlation between the indexes and PSI was investigated. BNP levels for survivor and non-survivor groups were compared, and a receiver operating characteristic (ROC) curve analysis was performed on the BNP levels versus PSI. RESULTS: The BNP levels increased with CAP severity (r=0.782, P<0.001). The BNP levels of the high-risk group (PSI classes Ⅳ and Ⅴ) were significantly higher than those of the low-risk group (PSI classes Ⅰ–Ⅲ) (P<0.001). The BNP levels were significantly higher in the non-survivor group than in the survivor group (P<0.001). In addition, there were positive correlations between BNP levels and PSI scores (r=0.782, P<0.001). The BNP level was highly accurate in predicting the severity of CAP (AUC=0.952). The optimal cut-off point of BNP level for distinguishing high-risk patients from low-risk ones was 125.0 pg/mL, with a sensitivity of 0.891 and a specificity of 0.946. Moreover, BNP level was accurate in predicting mortality (AUC=0.823). Its optimal cut-off point for predicting death was 299.0 pg/mL, with a sensitivity of 0.675 and a specificity of 0.816. Its negative predictive cut-off value was 0.926, and the positive predictive cut-off value was 0.426. CONCLUSION: BNP level is positively correlated with the severity of CAP, and may be used as a biomarker for evaluating the severity of CAP.

AN APPROACH TO CHEST INFECTIONS IN ADULTS

Chest infections are a diverse group of infections of the airways and lungs, the most common of which are pneumonia and acute bronchitis. A well-taken history and examination will often reveal the type of chest infection a patient has, guide the choice of antibiotics and reveal features that would prompt a referral to hospital. Many of these infections can be treated on an outpatient basis in the community. Some will need a referral for hospital admission or respiratory specialist review. This paper will cover an approach to history and examination in patients with symptoms of chest infection. Several validated tools to aid clinical decision-making will be covered and these provide evidence-based and useful guidelines to a busy family physician. This paper will also cover some current antibiotic guidelines, a patient’s journey through an emergency department visit, and some advice to patients on discharge.

The value of D-dimer in assessing severity and predicting long-term prognosis in patients with community acquired pneumonia / 中华急诊医学杂志

Objective To evaluate the value of D-dimer in assessing severity and predicting longterm prognosis in patients with community acquired pneumonia (CAP).Methods From June 2009 to December 2010,a total of 189 patients with CAP were enrolled.After admission,D-dimer,procalcitonin (PCT) and C-reactive protein (CRP) were measured,and Pneumonia Severity Index (PSI) was calculated.They were assigned into two groups according to their D-dimer levels:high D-dimer levels group (D-dimer levels≥500 μg/L) and normal D-dimer levels group (D-dimer levels ＜ 500 μg/L).The followup time was one year.A Kaplan-Meier survive curve was constructed to assess the 1-year mortality,and multivariate logistic regression analysis were used to assess the value of D-dimer for predicting long-term prognosis.Results D-dimer levels increased with increasing PSI class [class Ⅰ-Ⅲ:378.37 μg/L (216.74,649.50) μg/L; class Ⅳ:673.41 μg/L (544.77,866.85) μg/L; class Ⅴ:831.58 μg/L (591.78,1066.39) μg/L,x2 =56.58,P ＜ 0.01].The Kaplan-Meier survival curve showed that 1-year mortality rate of high D-dimer levels group was higher than normal D-dimer levels group (log-rank test,x2 =52.51,P ＜ 0.01).The multivariate logistic regression analysis showed an independent relationship between higher D-dimer levels and long-term mortality (OR =2.05,95％ CI:1.48-2.61,P ＜ 0.01).Conclusion D-dimer is an independent predictor of severity and long-term prognosis in patients with CAP.

Assessment application of the modified CURB-65 score for emergency community-acquired pneumonia / 中华急诊医学杂志

Objective To evaluate the clinical application value of modified CURB-65 score for assessing severity of community-acquired pneumonia (CAP) in emergency patients.Methods During the period from May 2011 to May 2012,198 emergency patients with CAP enrolled in this study were evaluated by CURB-65 score and modified CURB-65 score,respectively.Based on the severity of CAP,patients were divided into mild pneumonia group (Group A,n =107) and severe pneumonia group (Group B,n =91).The clinical status and biomarkers (the white blood cell count,procalcitonin,pneumonia severity index,hospitalization days,and hospitalization expenses) were recorded and compared with t test.Group B was divided into survived-subgroup (n =62) and death-subgroup (n =29).The differences in CURB-65 score and modified CURB-65 scere between the two groups were compared with t test.The correlation of CURB-65 score and modified CURB-65 score with procalcitonin,pneumonia severity index,hospitalization days,and hospitalization expenses were determined with Pearson rank correlation method.Results The procalcitonin,pneumonia severity index,hospitalization days,hospitalization expenses,modified CURB-65 score and CURB-65 score in Group B were significantly higher than those in Group A [(3.70 ± 0.83) vs.(1.27±0.24),t=28.91,P＜0.01; (121.33±16.74) vs.(73.79±9.21),t=25.23,P＜0.01;(25.79±10.13) vs.(14.85 ±6.83),t=9.02,P＜0.01; (22.71 ±3.84) vs.(9.83 ±1.24),t=32.76,P＜0.01; (3.69±1.03) vs.(3.32±1.06),t=2.48,P＜0.05; (4.21±1.13) vs.(3.41±0.96),t =5.39,P＜0.01],while no significant difference was observed in the white blood cell count between GroupA and B (17.58 ±5.99 vs.16.86±4.41,t =0.97,P＞0.05).For Group B,the modified CURB-65 score of death-subgroup was significantly higher than that of survived-subgroup [(4.75± ± 1.17) vs.(4.01 ± 1.09),t =2.95,P ＜ 0.01],whilc no significant difference was observed in the CURB-65 score between the death-subgroup and survived-subgroup (4.01 ± 1.15 vs.3.58 ±0.97,t =1.86,P ＞ 0.05).The CURB-65 score positive correlated with the procalcitonin (r =-0.803,P =0.025),and had no obvious correlation with the pneumonia severity index,hospitalization days,and hospitalization expenses (r=0.621,P=0.320; r=0.701,P=0.231; r=0.675,P=0.256); The modified CURB-65 score significantly positively correlated with the procalcitonin,pneumonia severity index,hospitalization days,and hospitalization expenses (r =0.951,P =0.003 ; r =0.965,P =0.002 ; r =0.947,P =0.004 ; r =0.961,P =0.002).Conclusions Compared with the CURB-65 score,the modified CURB-65 score is more efficient in evaluating the severity and prognoses of CAP for emergency patients.

The roles of using B-type natriuretic peptide to predict the severity of community-acquired pneumonia / 中华急诊医学杂志

Objective To evaluate the roles of B-type natriuretic peptide (BNP) in predicting the severity of community-acquired pneumonia (CAP) by studying the correlation between them.Methods A total of 202 patients with CAP admitted from December 2011 to December 2012 were enrolled in this study.All these patients were checked with laboratory tests for BNP level,C-reactive protein (CRP),white blood cell count (WBC) as well as other markers needed for obtaining pneumonia severity index (PSI).The differences in BNP levels,CRP levels,and WBC were compared among different degrees of pneumonia severity,and the correlation between BNP levels and PSI was investigated by a linear correlation analysis.The patients enrolled were divided into a high-risk group (defined as Ⅳ-Ⅴ grade of PSI) and a low-risk group (defined as Ⅰ-Ⅲgrade of PSI).Meanwhile,they were also divided into a survivor group and a non-survivor group according to outcomes.BNP levels between the two groups were compared,and a receiver operating characteristic (ROC) curve analysis was performed on the BNP levels versus PSI.Results BNP levels increased with CAP severity (r =0.782,P ＜0.01).The mean level of BNP (263.2 ± 119.6) pg/mLof patients in the high-risk group was significantly higher than that of patients (71.5 ± 54.3) pg/mL in the low-risk group (P ＜ 0.01).The patients in the non-survivor group had significantly higher BNP levels compared to the survivor group [(343.86 ± 125.49) vs.(183.00 ±121.71) pg/mL,P ＜ 0.01].In addition,there were positive correlations between BNP levels and PSI (r =0.782,P＜0.001),between BNP levels and CRP levels (r =0.560,P＜0.01),and between BNP levels and WBC (r =0.513,P＜0.001).The BNP level had a high accuracy in predicting the severity of CAP (AUC =0.952).The optimal cut-off point of BNP level for distinguishing high-risk from low-risk patients was 125.0 pg/mL,with a semitivity of 0.891 and a specificity of 0.946.Moreover,BNP level had a definite accuracy in predicting mortality (AUC =0.823).Its optimal cut-off point for predicting death was 299.0 pg/mL,with a sensitivity of 0.675 and a specificity of 0.816; its negative predictive cut-off value was 0.926,and positive predictive value was 0.426.Conclusions BNP level is positively correlated with the severity of CAP.The patient with BNP level above 125.0 pg/mL should be hospitalized immediately and patients with BNP level higher than 299.0 pg/mL are at the high risk of death.Therefore,BNP is a useful biomarker for evaluating the severity of patients with CAP.

Evaluation of the mannose-binding lection gene polymorphism on the severity of community acquired pneumonia in adults / 中华危重病急救医学

Objective To evaluate the significance of the mannose-binding lection (MBL) gene polymorphism at code 54 of exon 1 and MBL serum level and C-reactive protein (CRP) in the severity of community acquired pneumonia (CAP) in adults.Methods A prospective observation was conducted.104 adults Han patients with CAP hospitalized in Tianjin People's Hospital were enrolled.Frequencies of MBL54 alleles and genotypes were measured.The patients were evaluated by pneumonia severity index (PSI) score and were graded.Serum MBL was determined by enzyme linked immunosorbent assay (ELISA),and serum CRP was detected by immunoturbidimetry before and 4 days and 7 days after the treatment.100 healthy control subjects with the same region,age,gender,nationality were enrolled as control group.Serum MBL and CRP levels were compared between CAP group and the control group or among different grades of PSI,and the correlation was analyzed.Results The variation of GGC→GGC in MBL54 was found in CAP patients and controls.Similar frequencies of genotypes (x2=0.018,P=0.893) and alleles (x2=0.019,P=0.903) of MBL54 with wild type and mutant type were found between two groups.The serum MBL level (mg/L) before and 4 days and 7 days after the treatment in CAP group was increased followed by the reduction and they were 3.75 ± 1.78,4.53 ± 1.99 and 4.04 ± 1.91,respectivelv,which were significantly higher than those in control group (2.84 ± 1.41,all P＜0.01).The serum CRP levels (mg/L) in CAP group were gradually declined,and they were 66.88 ± 40.47,51.21 ± 37.54,36.91 ± 36.02,respectively,which were significantly higher than those in control group (6.96 ± 2.19,all P＜0.01).There were 12 cases with PSI grade Ⅰ,32 cases with grade Ⅱ,20 cases with grade Ⅲ,22 cases with grade Ⅳ and 18 cases with grade V in CAP patients.There was no significant difference in frequencies of MBL54 genotypes among different grades of PSI (x2=1.210,P=0.876) and between general ward and intensive care unit (x2=0.569,P=0.451).No differences in the serum MBL level before (F=1.313,P=0.279) and 4 days (F=1.705,P=0.165) and 7 days (F=1.684,P=0.170) after the treatment were found among different PSI grades.The serum MBL level 4 days after the treatment was significantly higher than that before treatment,then decreased to the level before treatment on the 7th day after treatment in CAP patients with grade Ⅱ-Ⅳ.There was significant difference in serum CRP level before (F=23.179,P=0.000) and 4 days (F=26.601,P=0.000) and 7 days (F=10.358,P=0.000) after the treatment among different PSI grades in CAP patients.The serum levels of CRP in patients with different PSI grades were gradually decreased with time prolonged,the higher the PSI grade,the more obscure the serum CRP decrease.No correlation was found between PSI grade and serum MBL before and 4 days and 7 days after the treatment (before treatment:r=-0.205,P=0.145; 4 days after treatment:r=-0.062,P=0.662; 7 days after treatment:r=-0.063,P=0.656),and positive correlation between PSI grade and serum CRP was found (before treatment:r=0.809,P=0.000; 4 days after treatment:r=0.842,P=0.000; 7 days after treatment:r=0.702,P=0.000).Conclusions The MBL54 codon genotypes had no effect on the susceptibility of CAP.The serum MBL was elevated and dynamic changes with increasing treatment time in CAP patients were shown.MBL can be used as a reaction of CAP in acute stage.But it cannot be used as an inflammatory marker for the severity of CAP.

Serum procalcitanin level in patients with community-acquired pneumonia and its clinical significance / 中国医师进修杂志

Objective To investigate the change and clinical significance of serum procalcitonin (PCT) level in patients with community-acquired pneumonia (CAP).Methods One hundred and forty-five CAP patients were enrolled.Serum PCT level was measured by immunofluorescent antibody staining method.CURB-65 score and pneumonia severity index (PSI) score were used to evaluate the severity of the patients with CAP.Correlations between PCT and blood white blood cell (WBC) count,serum C-reactive protein (CRP),PSI score,CURB-65 score,hospitalization duration and mortality were analyzed with Pearson correlation analysis,Logistic regression analysis and so on.Results Serum PCT in patients with CAP showed positively correlated with CURB-65 score and PSI score (r =0.606,0.943,P＜ 0.01 ),and serum PCT was also positively correlated with age,serum CRP and hospitalization duration (r =0.753,0.233,0.281,P ＜0.01),but it wasn't correlated with blood WBC count (r =0.152,P ＞0.05).Logistic regression analysis showed that each increment of 1 μ g/L for serum PCT would increase 2.828-fold for the risk of death in CAP patients.Conclusions Serum PCT predicts the sensitivity and specificity of CAP with a similar prognostic accuracy with CURB-65 score and PSI score.Serum PCT in patients with CAP correlates with hospitalization duration and mortality.Therefore,it is a promising prognostic marker to evaluate the severity and outcome of CAP.It may serve as a useful marker for clinicians to evaluate the severity and prognosis of CAP.

The effect of C-reactive protein in assessing the disease severity and prognosis of community-acquired pneumonia / 中国综合临床

Objective To explore the changes of serum C-reactive protein(CRP)and pneumonia severity index(PSI)of community-acquired pneumonia(CAP)and further assess the effect of CRP on the severity and prognosis of CAP.Methods One hundred and six cases of patients with CAP hospitalized from January 2009 to May 2011 were retrospectively analyzed.Patients were classified according to different assessment criteria and age(≥65 years old)and serum CRP was detected in all patients.Results CRP was correlated positively with PSI(r =0.453,P ＜ 0.001).CRP and PSI had no correlation in elderly hospitalized patients with CAP,but CRP([81.70 ± 75.63]mg/L)correlated positively with PSI(78.30 ± 42.63)in non-elderly patients(r =0.489,P ＜ 0.001).There was significant difference on PSI(89.24 ± 36.44 vs 53.59 ± 35.41),CRP ([106.93 ±74.76]mg/L vs[31.34 ±33.68]mg/L)between PSI severity group and PSI non-severity group (t =-4.289,-5.934,respectively,P ＜ 0.001).Conclusion Both CRP and PSI can be used to evaluate the severity of community-acquired pneumonia,and CRP can be used as a supplement to PSI scoring system,especially in the assessment of non-elderly patients.

Validity of pneumonia severity index and CURB-65 severity scoring systems in community acquired pneumonia in an indian setting.

Background. Little information is available from India regarding prognostic factors in patients with community acquired pneumonia (CAP). Methods. Hospital-based prospective study to test the validity of pneumonia severity index (PSI) and the confusion, urea, respiratory rate, blood pressure, age over 65 years (CURB-65) risk scoring systems in patients with CAP (n=150). Results. Although both CURB-65 class ³III and PSI class ³IV were 100% sensitive in predicting death, CURB-65 class ³III had a higher specificity (74.6%) than PSI class ³IV (52.2%) when used to predict death. In both PSI and CURB-65 risk scoring systems, mortality rate, need for intensive care unit (ICU) admission, prolonged need for intravenous (I.V.) antibiotics, prolonged duration of hospital stay and need for admission to ICU increased progressively with increasing scores. The PSI class ³IV was more sensitive in predicting ICU admission than CURB-65. The duration of hospital stay was found to have a weak but significant correlation with PSI and CURB-65 criteria. Defervescence time also had a very weak but significant correlation with PSI and CURB-65 criteria. Duration of I.V. antibiotics had a moderately strong correlation with CURB-65 criteria but a weak correlation with PSI criteria. Conclusions. Both PSI and CURB-65 were found to have equal sensitivity to predict death from CAP. Specificity of CURB- 65 was higher than that of PSI. However, PSI was more sensitive in predicting ICU admission than CURB-65.

Effectiveness of a Pneumonia Severity Index (PSI) as a Predictor of Mortality in Emergency Department Patients with Community-Acquired Pneumonia

PURPOSE: Pneumonia is the most common cause of death among infectious diseases. Community-acquired pneumonia is the sixth leading cause of death in Korea. This study was designed to analyze the relationship of risk factors and mortality, especially the pneumonia severity index (PSI) in patients with community-acquired pneumonia diagnosed in the emergency department of a referral hospital. METHODS: The medical records of patients admitted to the Yeungnam University Hospital between March 2006 and March 2008 for community-acquired pneumonia were reviewed retrospectively. The demographic data, comorbidity, laboratory results, PSI score and class of PSI, all of which might influence the prognosis of pneumonia, were analyzed. RESULTS: Among 123 patients admitted for community-acquired pneumonia, 18 died (mortality rate of 15%). Laboratory data showed that sodium, glucose, blood urea nitrogen, albumin, platelets, hematocrit and arterial pH were related to the prognosis. For the pneumonia severity index, the mortality rate increased in a step-wise manner from class I through class V. Comorbidities such as neoplasms (p=0.000), cerebrovascular accidents (p=0.005) and liver disease (p=0.003), as well as systolic blood pressure (p=0.003), respiratory rate (p=0.024), sodium (p=0.000), glucose (p=0.000), blood urea nitrogen (p=0.000), albumin (p=0.003), hematocrit (p=0.000) and arterial pH (p=0.042) were the important risk factors for mortality in patients with community-acquired pneumonia. CONCLUSION: The pneumonia severity index could be used as a valuable index for predicting mortality of patients and the prognosis of community-acquired pneumonia in the emergency department.

Modified Triage Method by Pneumonia Severity Index for Patients with Community: acquired pneumonia

PURPOSE: Considerable variation exists in hospital admission rates for patients with community-acquired pneumonia (CAP). The objective of this study was to evaluate whether the pneumonia severity index (PSI) could be applied to patients with CAP as a method for triage in an emergency medical center. METHODS: A total number of 110 patients admitted with community-acquired pneumonia between January 1997 and September 2001. Their medical records were reviewed, with pneumonia severity index, and other risk factors, the time to resolution, and the results of treatment being evaluated. RESULTS: The pneumonia severity index accurately identified the patients with community-acquired pneumonia. Factors we evaluated were related to significant differences statistically, including such as PaCO2, WBC count, suffered lobe count, hypoxic index (PaO2/ F i O2), diabetes, hypertension, number of coexisting illness, period of admission and intravenous antibiotic therapy, and aggravated PaO2. If body temperature was less than 38.5 degrees C, it was considerable for outpatients clinics in Class I and II. CONCLUSION: The pneumonia severity index was a useful screening tool for patients with community-acquired pneumonia. Admission and an active therapeutic plan could be recommended for patients assigned to Class III. Inappropriate admissions were reduced to 27.3% by modified triage algorithm.