Your browser doesn't support javascript.
A prediction rule for severe adverse events in all inpatients with community-acquired pneumonia: a multicenter observational study.
Sakakibara, Toshihiro; Shindo, Yuichiro; Kobayashi, Daisuke; Sano, Masahiro; Okumura, Junya; Murakami, Yasushi; Takahashi, Kunihiko; Matsui, Shigeyuki; Yagi, Tetsuya; Saka, Hideo; Hasegawa, Yoshinori.
  • Sakakibara T; Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
  • Shindo Y; Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan. yshindo@med.nagoya-u.ac.jp.
  • Kobayashi D; Kyoto University Health Service, Kyoto, Japan.
  • Sano M; Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
  • Okumura J; Department of Respiratory Medicine, Higashi Nagoya National Hospital, Nagoya, Japan.
  • Murakami Y; Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
  • Takahashi K; Department of Respiratory Medicine, Toyota Memorial Hospital, Toyota, Japan.
  • Matsui S; Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
  • Yagi T; Department of Biostatistics, Nagoya University Graduate School of Medicine, Nagoya, Japan.
  • Saka H; Department of Biostatistics, M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan.
  • Hasegawa Y; Department of Biostatistics, Nagoya University Graduate School of Medicine, Nagoya, Japan.
BMC Pulm Med ; 22(1): 34, 2022 Jan 12.
Article in English | MEDLINE | ID: covidwho-1619908
ABSTRACT

BACKGROUND:

Prediction of inpatients with community-acquired pneumonia (CAP) at high risk for severe adverse events (SAEs) requiring higher-intensity treatment is critical. However, evidence regarding prediction rules applicable to all patients with CAP including those with healthcare-associated pneumonia (HCAP) is limited. The objective of this study is to develop and validate a new prediction system for SAEs in inpatients with CAP.

METHODS:

Logistic regression analysis was performed in 1334 inpatients of a prospective multicenter study to develop a multivariate model predicting SAEs (death, requirement of mechanical ventilation, and vasopressor support within 30 days after diagnosis). The developed ALL-COP-SCORE rule based on the multivariate model was validated in 643 inpatients in another prospective multicenter study.

RESULTS:

The ALL-COP SCORE rule included albumin (< 2 g/dL, 2 points; 2-3 g/dL, 1 point), white blood cell (< 4000 cells/µL, 3 points), chronic lung disease (1 point), confusion (2 points), PaO2/FIO2 ratio (< 200 mmHg, 3 points; 200-300 mmHg, 1 point), potassium (≥ 5.0 mEq/L, 2 points), arterial pH (< 7.35, 2 points), systolic blood pressure (< 90 mmHg, 2 points), PaCO2 (> 45 mmHg, 2 points), HCO3- (< 20 mmol/L, 1 point), respiratory rate (≥ 30 breaths/min, 1 point), pleural effusion (1 point), and extent of chest radiographical infiltration in unilateral lung (> 2/3, 2 points; 1/2-2/3, 1 point). Patients with 4-5, 6-7, and ≥ 8 points had 17%, 35%, and 52% increase in the probability of SAEs, respectively, whereas the probability of SAEs was 3% in patients with ≤ 3 points. The ALL-COP SCORE rule exhibited a higher area under the receiver operating characteristic curve (0.85) compared with the other predictive models, and an ALL-COP SCORE threshold of ≥ 4 points exhibited 92% sensitivity and 60% specificity.

CONCLUSIONS:

ALL-COP SCORE rule can be useful to predict SAEs and aid in decision-making on treatment intensity for all inpatients with CAP including those with HCAP. Higher-intensity treatment should be considered in patients with CAP and an ALL-COP SCORE threshold of ≥ 4 points. TRIAL REGISTRATION This study was registered with the University Medical Information Network in Japan, registration numbers UMIN000003306 and UMIN000009837.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia / Severity of Illness Index / Community-Acquired Infections / Risk Assessment / Clinical Decision Rules Type of study: Diagnostic study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Adult / Aged / Female / Humans / Male / Middle aged / Young adult Country/Region as subject: Asia Language: English Journal: BMC Pulm Med Year: 2022 Document Type: Article Affiliation country: S12890-022-01819-0

Similar

MEDLINE

...
LILACS

LIS


Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia / Severity of Illness Index / Community-Acquired Infections / Risk Assessment / Clinical Decision Rules Type of study: Diagnostic study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Adult / Aged / Female / Humans / Male / Middle aged / Young adult Country/Region as subject: Asia Language: English Journal: BMC Pulm Med Year: 2022 Document Type: Article Affiliation country: S12890-022-01819-0