The International Community-Acquired Pneumonia (CAP) Collaboration Cohort (ICCC) study: rationale, design and description of study cohorts and patients

Abstract

ObjectiveTo improve the understanding of the determinants of prognosis and accurate risk stratification in community-acquired pneumonia (CAP).DesignMulticentre collaboration of prospective cohorts.Setting6 cohorts from the USA, Canada, Hong Kong and Spain.ParticipantsFrom a published meta-analysis of risk stratification studies in CAP, the authors identified and pooled individual patient-level data from six prospective cohort studies of CAP (three from the USA, one each from Canada, Hong Kong and Spain) to create the International CAP Collaboration Cohort. Initial essential inclusion criteria of meta-analysis were (1) prospective design, (2) in English language, (3) reported 30-day mortality and transfer to an intensive or high dependency care and (4) minimum 1000 participants. Common baseline patient characteristics included demographics, history and physical examination findings, comorbidities and laboratory and radiographic findings.Primary and secondary outcome measuresThis paper reports the rationale, hypotheses and analytical framework and also describes study cohorts and patients. The authors aim to (1) compare the prognostic accuracy of existing CAP risk stratification tools, (2) assess patient-level determinants of prognosis, (3) improve risk stratification by combined use of scoring systems and (4) understand prognostic factors for specific patient groups.ResultsThe six cohorts assembled from 1991 to 2007 included 13 784 patients (median age 71 years, 54% men). Aside from one randomised controlled study, the remaining five were cohort studies, but all had similar inclusion criteria. Overall, there was 0%–6% missing data. A total of 6159 (44%) had severe pneumonia by Pneumonia Severity Index class IV/V. Mortality at 30 days was 8% (1036). Admission to intensive care or high dependency unit was also 8% (1059).ConclusionsInternational CAP Collaboration Cohort provides a pooled multicentre data set of patients with CAP, which will help us to better understand the prognosis of CAP.

In-hospital mortality risk factors in community acquired pneumonia: evaluation of immunocompetent adult patients without comorbidities

“…11,15,[21][22][23][24][25][26][27] We observed in our casuistry that these score systems had fair strength of agreement with important difference between them in classifying CAP severity, similar to reported data. [21][22][23][24][25][26][27] In our study, CURB-65 and the SCAP scores were applied in order to assess if they might be useful to predict inhospital mortality. In this regard, CURB-65 score had a better performance than the SCAP score with an area under the ROC curve of 81%, which is comparable to the results of other studies.…”

Improvement of CRB-65 as a prognostic tool in adult patients with community-acquired pneumonia

“… 1–4 In a recently published multicentre study of prospective cohorts of patients with CAP mortality at 30 days, admission to intensive care or high-dependency units was 8%. 5 The annual cost of pneumonia in Europe, as estimated by the European Respiratory Society, is €10.1 billion, with in-patient care costs of €5.7 billion. 6…”

Comprehensive Molecular Testing for Respiratory Pathogens in Community-Acquired Pneumonia

“…Community-acquired pneumonia (CAP) is a common infectious disease with an estimated incidence of 2-11 cases per 1000 adults in the developed world and a mortality rate of 2%-14% [1][2][3][4][5]. Due to the range of pathogens responsible for CAP, in moderate or severe infection, broad-spectrum antimicrobial cover should be initiated before de-escalating to narrowspectrum pathogen-directed agents once a microbiological diagnosis has been made [1,5].…”