Application and comparison of scoring indices to predict outcomes in patients with healthcare-associated pneumonia

Wen-Feng Fang, Kuang-Yao Yang, Chieh-Liang Wu, Chong-Jen Yu, Chang-Wen Chen, Chih-Yen Tu, Meng-Chih Lin, Wen-Feng Fang, Kuang-Yao Yang, Chieh-Liang Wu, Chong-Jen Yu, Chang-Wen Chen, Chih-Yen Tu, Meng-Chih Lin

Abstract

Introduction: Healthcare-associated pneumonia (HCAP) is a relatively new category of pneumonia. It refers to infections that occur prior to hospital admission in patients with specific risk factors following contact or exposure to a healthcare environment. There is currently no scoring index to predict the outcomes of HCAP patients. We applied and compared different community acquired pneumonia (CAP) scoring indices to predict 30-day mortality and 3-day and 14-day intensive care unit (ICU) admission in patients with HCAP.

Methods: We conducted a retrospective cohort study based on an inpatient database from six medical centers, recruiting a total of 444 patients with HCAP between 1 January 2007 and 31 December 2007. Pneumonia severity scoring indices including PSI (pneumonia severity index), CURB 65 (confusion, urea, respiratory rate, blood pressure, age 65), IDSA/ATS (Infectious Diseases Society of America/American Thoracic Society), modified ATS rule, SCAP (severe community acquired pneumonia), SMART-COP (systolic blood pressure, multilobar involvement, albumin, respiratory rate, tachycardia, confusion, oxygenation, pH), SMRT-CO (systolic blood pressure, multilobar involvement, respiratory rate, tachycardia, confusion, oxygenation), and SOAR (systolic blood pressure, oxygenation, age, respiratory rate) were calculated for each patient. Patient characteristics, co-morbidities, pneumonia pathogen culture results, length of hospital stay (LOS), and length of ICU stay were also recorded.

Results: PSI (>90) has the highest sensitivity in predicting mortality, followed by CURB-65 (≥2) and SCAP (>9) (SCAP score (area under the curve (AUC): 0.71), PSI (AUC: 0.70) and CURB-65 (AUC: 0.66)). Compared to PSI, modified ATS, IDSA/ATS, SCAP, and SMART-COP were easy to calculate. For predicting ICU admission (Day 3 and Day 14), modified ATS (AUC: 0.84, 0.82), SMART-COP (AUC: 0.84, 0.82), SCAP (AUC: 0.82, 0.80) and IDSA/ATS (AUC: 0.80, 0.79) performed better (statistically significant difference) than PSI, CURB-65, SOAR and SMRT-CO.

Conclusions: The utility of the scoring indices for risk assessment in patients with healthcare-associated pneumonia shows that the scoring indices originally designed for CAP can be applied to HCAP.

References

    1. Carratala J, Garcia-Vidal C. What is healthcare-associated pneumonia and how is it managed? Current Opinion in Infectious Diseases. 2008;21:168–173. doi: 10.1097/QCO.0b013e3282f4f248.
    1. Kollef MH, Shorr A, Tabak YP, Gupta V, Liu LZ, Johannes RS. Epidemiology and outcomes of health-care-associated pneumonia: results from a large US database of culture-positive pneumonia. Chest. 2005;128:3854–3862. doi: 10.1378/chest.128.6.3854.
    1. Shindo Y, Sato S, Maruyama E, Ohashi T, Ogawa M, Hashimoto N, Imaizumi K, Sato T, Hasegawa Y. Health-care-associated pneumonia among hospitalized patients in a Japanese community hospital. Chest. 2009;135:633–640. doi: 10.1378/chest.08-1357.
    1. Polverino E, Torres A. Diagnostic strategies for healthcare-associated pneumonia. Seminars in Respiratory and Critical Care Medicine. 2009;30:36–45. doi: 10.1055/s-0028-1119807.
    1. Carratala J, Mykietiuk A, Fernandez-Sabe N, Suarez C, Dorca J, Verdaguer R, Manresa F, Gudiol F. Health care-associated pneumonia requiring hospital admission: epidemiology, antibiotic therapy, and clinical outcomes. Archives of Internal Medicine. 2007;167:1393–1399. doi: 10.1001/archinte.167.13.1393.
    1. Micek ST, Kollef KE, Reichley RM, Roubinian N, Kollef MH. Health care-associated pneumonia and community-acquired pneumonia: a single-center experience. Antimicrobial Agents and Chemotherapy. 2007;51:3568–3573. doi: 10.1128/AAC.00851-07.
    1. Renaud B, Coma E, Labarere J, Hayon J, Roy PM, Boureaux H, Moritz F, Cibien JF, Guerin T, Carre E, Lafontaine A, Bertrand MP, Santin A, Brun-Buisson C, Fine MJ, Roupie E. Pneumocom Study Investigators. Routine use of the Pneumonia Severity Index for guiding the site-of-treatment decision of patients with pneumonia in the emergency department: a multicenter, prospective, observational, controlled cohort study. Clin Infect Dis. 2007;44:41–49. doi: 10.1086/509331.
    1. Marrie TJ. The Pneumonia Severity Index score: time to move to a prospective study of patients with community-acquired pneumonia who are discharged from emergency departments to be managed on an ambulatory basis. Clin Infect Dis. 2007;44:50–52. doi: 10.1086/509333.
    1. Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, Coley CM, Marrie TJ, Kapoor WN. A prediction rule to identify low-risk patients with community-acquired pneumonia. The New England Journal of Medicine. 1997;336:243–250. doi: 10.1056/NEJM199701233360402.
    1. Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM Jr, Musher DM, Niederman MS, Torres A, Whitney CG. Infectious Diseases Society of America; American Thoracic Society. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44:S27–72. doi: 10.1086/511159.
    1. Espana PP, Capelastegui A, Quintana JM, Bilbao A, Diez R, Pascual S, Esteban C, Zalacain R, Menendez R, Torres A. Validation and comparison of SCAP as a predictive score for identifying low-risk patients in community-acquired pneumonia. J Infect. 2010;60:106–113. doi: 10.1016/j.jinf.2009.11.013.
    1. El-Solh AA, Alhajhusain A, Abou Jaoude P, Drinka P. Validity of Severity Scores in Hospitalized Patients with Nursing Home Acquired Pneumonia. Chest. 2010;138:1371–1376. doi: 10.1378/chest.10-0494.
    1. Brito V, Niederman MS. Healthcare-associated pneumonia is a heterogeneous disease, and all patients do not need the same broad-spectrum antibiotic therapy as complex nosocomial pneumonia. Current Opinion in Infectious Diseases. 2009;22:316–325. doi: 10.1097/QCO.0b013e328329fa4e.
    1. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. American Journal of Respiratory and Critical Care Medicine. 2005;171:388–416. doi: 10.1164/rccm.200405-644ST.
    1. Lauderdale TL, Chang FY, Ben RJ, Yin HC, Ni YH, Tsai JW, Cheng SH, Wang JT, Liu YC, Cheng YW, Chen ST, Fung CP, Chuang YC, Cheng HP, Lu DC, Liu CJ, Huang IW, Hung CL, Hsiao CF, Ho M. Etiology of community acquired pneumonia among adult patients requiring hospitalization in Taiwan. Respiratory Medicine. 2005;99:1079–1086. doi: 10.1016/j.rmed.2005.02.026.
    1. Ewig S, Ruiz M, Mensa J, Marcos MA, Martinez JA, Arancibia F, Niederman MS, Torres A. Severe community-acquired pneumonia. Assessment of severity criteria. American Journal of Respiratory and Critical Care Medicine. 1998;158:1102–1108.
    1. Ewig S, de Roux A, Bauer T, Garcia E, Mensa J, Niederman M, Torres A. Validation of predictive rules and indices of severity for community acquired pneumonia. Thorax. 2004;59:421–427. doi: 10.1136/thx.2003.008110.
    1. Myint PK, Kamath AV, Vowler SL, Maisey DN, Harrison BD. Severity assessment criteria recommended by the British Thoracic Society (BTS) for community-acquired pneumonia (CAP) and older patients. Should SOAR (systolic blood pressure, oxygenation, age and respiratory rate) criteria be used in older people? A compilation study of two prospective cohorts. Age Ageing. 2006;35:286–291. doi: 10.1093/ageing/afj081.
    1. Espana PP, Capelastegui A, Gorordo I, Esteban C, Oribe M, Ortega M, Bilbao A, Quintana JM. Development and validation of a clinical prediction rule for severe community-acquired pneumonia. American Journal of Respiratory and Critical Care Medicine. 2006;174:1249–1256. doi: 10.1164/rccm.200602-177OC.
    1. Charles PG, Wolfe R, Whitby M, Fine MJ, Fuller AJ, Stirling R, Wright AA, Ramirez JA, Christiansen KJ, Waterer GW, Pierce RJ, Armstrong JG, Korman TM, Holmes P, Obrosky DS, Peyrani P, Johnson B, Hooy M. Australian Community-Acquired Pneumonia Study Collaboration. Grayson ML. SMART-COP: a tool for predicting the need for intensive respiratory or vasopressor support in community-acquired pneumonia. Clin Infect Dis. 2008;47:375–384. doi: 10.1086/589754.
    1. Lim WS, van der Eerden MM, Laing R, Boersma WG, Karalus N, Town GI, Lewis SA, Macfarlane JT. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 2003;58:377–382. doi: 10.1136/thorax.58.5.377.
    1. Restrepo MI, Anzueto A. The role of gram-negative bacteria in healthcare-associated pneumonia. Seminars in Respiratory and Critical Care Medicine. 2009;30:61–66. doi: 10.1055/s-0028-1119810.
    1. Capelastegui A, Espana PP, Quintana JM, Bilbao A, Menendez R, Zalacain R, Torres A. Development of a prognostic index for 90-day mortality in patients discharged after admission to hospital for community-acquired pneumonia. Thorax. 2009;64:496–501. doi: 10.1136/thx.2008.098814.
    1. Niederman MS. Making sense of scoring systems in community acquired pneumonia. Respirology (Carlton, Vic) 2009;14:327–335. doi: 10.1111/j.1440-1797.2008.01047.x.
    1. Yandiola PP, Capelastegui A, Quintana J, Diez R, Gorordo I, Bilbao A, Zalacain R, Menendez R, Torres A. Prospective comparison of severity scores for predicting clinically relevant outcomes for patients hospitalized with community-acquired pneumonia. Chest. 2009;135:1572–1579. doi: 10.1378/chest.08-2179.

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