The role of pneumonia scores in the emergency room in patients infected by 2009 H1N1 infection

Brandão-Neto, Rodrigo Antônio; Goulart, Alessandra Carvalho; Santana, Alfredo Nicodemos Cruz; Martins, Herlon Saraiva; Ribeiro, Sabrina Correa Costa; Ho, Li Y.; Chiamolera, Murilo; Magri, Marcelo M.C.; Scalabrini-Neto, Augusto; Velasco, Irineu Tadeu

doi:10.1097/mej.0b013e328349ed85

Cited by 16 publications

(21 citation statements)

References 4 publications

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“…Brandão‐Neto et al. [15] suggested in an observational study of 53 patients hospitalized for pandemic 2009 Influenza A (H1N1) that PSI and CURB‐65 perform poorly in this cohort of patients. In this study, these scores underestimate severity because, as in our study, a significant number of patients with low risk of mortality were admitted to the ICU.…”

Section: Discussionmentioning

confidence: 99%

Severity assessment tools in ICU patients with 2009 Influenza A (H1N1) pneumonia

Pereira

Moreno

Matos

et al. 2012

Clinical Microbiology and Infection

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The aim of this study was to determine if severity assessment tools (general severity of illness and community-acquired pneumonia specific scores) can be used to guide decisions for patients admitted to the intensive care unit (ICU) due to pandemic influenza A pneumonia. A prospective, observational, multicentre study included 265 patients with a mean age of 42 (±16.1) years and an ICU mortality of 31.7%. On admission to the ICU, the mean pneumonia severity index (PSI) score was 103.2 ± 43.2 points, the CURB-65 score was 1.7 ± 1.1 points and the PIRO-CAP score was 3.2 ± 1.5 points. None of the scores had a good predictive ability: area under the ROC for PSI, 0.72 (95% CI, 0.65-0.78); CURB-65, 0.67 (95% CI, 0.59-0.74); and PIRO-CAP, 0.64 (95% CI, 0.56-0.71). The PSI score (OR, 1.022 (1.009-1.034), p 0.001) was independently associated with ICU mortality; however, none of the three scores, when used at ICU admission, were able to reliably detect a low-risk group of patients. Low risk for mortality was identified in 27.5% of patients using PIRO-CAP, but above 40% when using PSI (I-III) or CURB65 (<2). Observed mortality was 13.7%, 13.5% and 19.4%, respectively. Pneumonia-specific scores undervalued severity and should not be used as instruments to guide decisions in the ICU.

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Section: Discussionmentioning

confidence: 99%

Severity assessment tools in ICU patients with 2009 Influenza A (H1N1) pneumonia

Pereira

Moreno

Matos

et al. 2012

Clinical Microbiology and Infection

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“…37 For patients admitted to the ICUs, the PIRO score has been developed. 19 There have also been other studies, which look at predictive value of pneumonia severity scores in other populations, including patients with H1N1 infection, 38 HIV infection 39 and chronic kidney disease. 40 Therefore, ICCC also provides a large cohort, which may be able to address the value of different pneumonia severity scores in specific populations.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2012

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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.

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“…42 Interestingly, CAP-specific scores demonstrated moderate usefulness for predicting ICU admission and/or mortality in hospitalized patients with influenza A(H1N1)pdm09 complicated by pneumonia in the REIPI cohort and other studies. 8,47 Consistent with these data, severity assessment tools (general severity of illness and CAP-specific scores) undervalued prognosis and should not be used as instruments to guide decisions on patients requiring ICU admission. 48 A limitation of these scores is that age is the variable with the most weight, and most patients affected by pneumonia during pandemic were younger adults.…”

Section: Severe Disease (Intensive Care Unit Admission and Mortality)mentioning

confidence: 99%

Influenza A(H1N1)pdm09-related pneumonia and other complications

Viasus

Oteo

Martínez‐Montauti

et al. 2012

Enfermedades Infecciosas y Microbiología Clínica

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Influenza A(H1N1)pdm09 virus infection was associated with significant morbidity, mainly among children and young adults. The majority of patients had self-limited mild-to-moderate uncomplicated disease. However, some patients developed severe illness and some died. In addition to respiratory complications, several complications due to direct and indirect effects on other body systems were associated with influenza A(H1N1)pdm09 virus infection. The main complications reported in hospitalized adults with influenza A(H1N1)pdm09 were pneumonia (primary influenza pneumonia and concomitant/secondary bacterial pneumonia), exacerbations of chronic pulmonary diseases (mainly chronic obstructive pulmonary disease and asthma), the need for intensive unit care admission (including mechanical ventilation, acute respiratory distress syndrome and septic shock), nosocomial infections and acute cardiac events. In experimentally infected animals, the level of pulmonary replication of the influenza A(H1N1)pdm09 virus was higher than that of seasonal influenza viruses. Pathological studies in autopsy specimens indicated that the influenza A(H1N1)pdm09 virus mainly targeted the lower respiratory tract, resulting in diffuse alveolar damage (edema, hyaline membranes, inflammation, and fibrosis), manifested clinically by severe acute respiratory distress syndrome with refractory hypoxemia. Influenza A(H1N1)pdm09-related pneumonia and other complications were associated with increased morbidity and mortality among hospitalized patients.

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The role of pneumonia scores in the emergency room in patients infected by 2009 H1N1 infection

Cited by 16 publications

References 4 publications

Severity assessment tools in ICU patients with 2009 Influenza A (H1N1) pneumonia

Severity assessment tools in ICU patients with 2009 Influenza A (H1N1) pneumonia

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

Influenza A(H1N1)pdm09-related pneumonia and other complications

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