Multimarker Prognostication for Hospitalized Patients with Community-acquired Pneumonia

Abstract

Objective The optimal prognostic model for community-acquired pneumonia (CAP) remains unclear. In this study, we sought to identify independent predictors of 30-day mortality in patients with CAP and to determine whether adding specific prognostic factors to each of the two clinical prediction scores could improve the prognostic yield. Methods This retrospective study involved 797 CAP patients who had been hospitalized at a tertiary referral center. The patients were categorized into two groups: those who survived and those who had died on or before 30 days after admission. Select clinical parameters were then compared between the two groups. Results During the 30-day period, there were 72 deaths (9%). We constructed two models for a multivariate analysis: one was based on a high CURB-65 score (3-5) and the other on a high pneumonia severity index (PSI) class (V). In both models, a high CURB-65 score or a high PSI class, along with the presence of dyspnea, high Eastern Cooperative Oncology Group (ECOG) performance status (3-4), and a low serum albumin level, were independent predictors of 30-day mortality. In both the CURB-65-based and PSI-based models, the addition of dyspnea, high ECOG performance status, and hypoalbuminemia (<3 g/dL) enhanced the prognostic assessment, and subsequently, the c-statistics calculated with the use of three-or four-predictor combinations exceeded 0.8. Conclusion In addition to the CURB-65 or PSI, the clinical factors of dyspnea, the ECOG performance status, and serum albumin level may be independent predictors of 30-day mortality in CAP patients. When combined with the CURB-65 or PSI, these parameters provide additional evidence for predicting poor prognoses.

<p>Age, Pulse, Urea and Albumin (APUA) Model: A Tool for Predicting in-Hospital Mortality of Community-Acquired Pneumonia Adapted for Patients with Type 2 Diabetes</p>

“…Studies from Japan and Korea showed that serum albumin is not less accurate than CURB-65 or PSI class for predicting 30-day mortality in CAP patients. 26,27 In this study, hypoalbuminemia was closely correlated with in-hospital mortality of CAP in T2DM patients. Compared to T2DM patients with albumin ≥35 g/L, T2DM patients with albumin 25-34.9 g/L [OR= 4.929] and albumin <25 g/L [OR= 12.463] were more likely to die at the time of hospitalization.…”

“…Some studies have proven that hypoalbuminemia significantly improved the performance of CURB-65 and PSI class for predicting mortality in patients with CAP. 17 , 26 , 34 , 35 However, CURB-65 and PSI class, particularly PSI class, are complicated scoring systems. Serum albumin makes the systems more complex.…”

Risk Factors for Frequent Infections in Patients With Extremely Severe Motor and Intellectual Disabilities

“…There is believed to be a link between malnutrition and inflammation, and hypoalbuminemia has been noted as an inflammatory marker associated with increased risk of poor clinical outcome [14]. Hypoalbuminemia can lead to weakened immunity and increased susceptibility to infectious diseases, and patients with sepsis have complex pathophysiological conditions, including immune imbalance and disorders of biosynthesis and catabolism [15]. Furthermore, hypoalbuminemia was found to be an independent predictor of fatal sepsis in an intensive care unit, with a 75.2% increase in the mortality rate among patients with serum albumin <2.9 g/dL [16].…”

A new predictive tool consolidating CURB-65 with procalcitonin and albumin to assess short-term mortality in hospitalized elderly patients with infectious disease: A retrospective study of a patient cohort

“…In parallel, for the assessment of prognosis of patients with community-acquired pneumonia, combined use of CURB-65 and PCT, [7–9,11,16,18,19] and combined use of CURB-65 and Alb, [6,10,12–14,21,27] have been widely applied. Alb is known to be a prognostic factor for elderly people.…”