Sepsis severity predicts outcome in community-acquired pneumococcal pneumonia

Abstract

Easily performed prognostic rules are helpful for guiding the intensity of monitoring and treatment of patients. The aim of the present study was to compare the predictive value of the sepsis score and the Confusion, Respiratory rate (o30 breaths?min -1 ), Blood pressure (systolic value ,90 mmHg or diastolic value f60 mmHg) and age o65 yrs (CRB-65) score in 105 patients with community-acquired pneumococcal pneumonia. In addition, the influence of timing of the antimicrobial treatment on outcome was investigated. The sepsis and the CRB-65 scores were used to allocate patients to subgroups with low, intermediate and high risk.Comparable, highly predictive values for mortality were found for both scores (sepsis score versus CRB-65): 1) low-risk group, 0 versus 0%; 2) intermediate-risk group, 0 versus 8.6%; 3) highrisk group, 30.6 versus 40%, with an area under the curve of 0.867 versus 0.845. Patients with ambulatory antibiotic pre-treatment had less severe disease with a lower acute physiology score, lower white blood cell count and a faster decline of C-reactive protein levels. No pre-treated patient died.In summary, both scores performed equally well in predicting mortality. The prediction of survival in the intermediate-risk group might be more accurate with the sepsis score. Pre-hospital antibiotic treatment was associated with less severe disease.

Rapid Identification of Microbes in Positive Blood Cultures by Use of the Vitek MS Matrix-Assisted Laser Desorption Ionization–Time of Flight Mass Spectrometry System

“…About 18 million cases occur worldwide each year, with a mortality rate of around 30% (1). The first 24 h of patient care is critical for determining and administering the appropriate antimicrobial therapy, and mortality rates increase by approximately 7% for every hour a septic patient remains untreated or receives inappropriate antimicrobial therapy (2).…”

Diretrizes brasileiras para pneumonia adquirida na comunidade em adultos imunocompetentes - 2009

“…In this score, each variable represents 1 point, and the total possible score comprises 4 points (CRB-65) or 5 points (CURB-65), as shown in Figures 2 and 3. (25,72,(75)(76)(77) The greatest limitation of the CURB-65 and CRB-65 is the fact that they do not include concomitant diseases that can increase the risk of CAP, e.g., alcoholism, heart failure, liver failure and neoplasia. • The possibility of treatment reevaluation should be guaranteed for CAP patients receiving home treatment (level III evidence).…”

Validity of British Thoracic Society guidance (the CRB-65 rule) for predicting the severity of pneumonia in general practice: systematic review and meta-analysis

“…The hospitalbased patients category is dominated by one large study that contributed 98% of the total patient dataset; 22 however, sensitivity analysis indicates that results are similar when this study is excluded from the meta-analysis. One study only measured patients who suffered from pneumococcal pneumonia, 19 but rather than exclude this study, it was included albeit that the event rate is low and is likely to produce an under-prediction of risk. While more studies validating CRB-65 in primary care are needed, it is likely that a large number of patients will need to be recruited to enable precise estimates of performance to be made.…”

“…8,[11][12][13][14][15][16][17][18][19][20][21][22][23] Table 1 summarises the characteristics of the included studies. Additional data were provided from three studies, 13,15,23 and clarification of included overlapping subjects obtained from two other studies.…”