Prognostic analysis and predictive rule for outcome of hospital-treated community-acquired pneumonia

Abstract

P Pr ro og gn no os st ti ic c aan na al ly ys si is s a an nd d p pr re ed di ic ct ti iv ve e r ru ul le e f fo or r o ou ut tc co om me e o of f h ho os sp pi it ta al l--t tr re ea at te ed d c co om mm mu un ni it ty y--a ac cq qu ui ir re ed d p pn ne eu um mo on ni ia a ABSTRACT: In community-acquired pneumonia (CAP) mortality may be reduced by early identification of patients requiring intensive care treatment. The purpose of this study was to determine prognostic factors of outcome in patients with CAP in order to establish a clinically applicable discriminant rule.Ninety three episodes of CAP in 92 patients were retrospectively reviewed with regard to epidemiological, clinical, laboratory and microbiological data. The prognostic analysis included a univariate as well as a multivariate approach, in order to identify parameters associated with death using the Cox regression hazard function in a backward stepwise selection model. The three parameters found to contribute most to the significance of the model were used in a discriminant rule for classification of outcome.The parameters found to be significantly different between survivors and nonsurvivors were heart rate, systolic and diastolic as well as mean blood pressures, leucocyte count, percentage of lymphocytes, and lactate dehydrogenase (LDH) values. The multivariate analysis revealed that heart rate, systolic arterial pressure, and LDH serum levels were most closely associated with fatal outcome. A prognostic rule composed of the variables heart rate ≥90 beats·min -1 , systolic arterial blood pressure ≤80 mmHg, and LDH ≥260 U·l -1 achieved a sensitivity of 77%, a specificity of 75%, and positive and negative predictive values of 42 and 93%, respectively. It was associated with a six fold increased risk of fatal outcome.In conclusion, heart rate, systolic blood pressure, and LDH values were most closely associated with death in a multivariate analysis. A discriminant rule consisting of these three variables achieved favourable classification results. The rule qualifies for further prospective validation, and may prove useful in the management of hospital-treated CAP.

Clinical significance of MCP-1 levels in BALF and serum in patients with interstitial lung diseases

“…These results confirm previous findings [4, 5, 13±15]. Moreover, LDH activity was confirmed as an adverse prognostic factor [5]. Conversely, the parameters diastolic blood pressure #60 mmHg and cardiac frequency $90 beats .…”

“…Although BTS rule 2 gave results very similar to the derivation and one validation study (sensitivity 47% and specificity 88% in the present series compared to 39 and 94% in the derivation study [4] and 35 and 89% in the validation study [7], respectively), BTS rule 1 failed to achieve the favourable performances reported in the derivation and two validation studies (sensitivity 65% and specificity 73% compared to 88 and 79% in the derivation study [4] and 70 and 84% [7] as well as 90 and 76% [8] in two validation studies, respectively). As regards the third rule, specificity was close to that reported in the derivation study (80% compared to 77%), but specificity achieved only 47% as compared to 77% in the derivation study [5]. These results suggest that rule 2 is the one that may most appropriately be applied to the elderly.…”

“…In order to ensure an appropriate identification of patients at risk of death caused by pneumonia, several prognostic rules for individual outcome have been suggested by the British Thoracic Society (BTS) [4] and by the authors [5]. Three validation studies of the BTS rules, in different settings, confirmed the potential of these rules in identifying patients at risk of death caused by pneumonia [6±8].…”

“…min -1 , LDH activity $260 U . L -1 [5]. Non survival was predicted by the presence of two of three variables and encoded "1".…”

Severity assessment in community-acquired pneumonia

“…With regards an alternative rule proposed by the authors [28], a satisfactory specificity of 80% could be confirmed but only a very limited sensitivity of 47% in this elderly population was found [41].…”