Utility of the Quick Sequential Organ Failure Assessment in Japanese patients with nursing‐ and healthcare‐associated pneumonia

Abstract

Aim To clarify the utility of sepsis evaluation using the Quick Sequential Organ Failure Assessment (qSOFA) tool in addition to the Pneumonia Severity Index (PSI); age, dehydration, respiration, orientation and blood pressure (A‐DROP) index; and immunodeficiency, respiration, orientation, age and dehydration (I‐ROAD) scoring systems, and risk factor evaluation of potentially drug‐resistant (PDR) pathogens are suggested in the 2017 guidelines for pneumonia of the Japanese Respiratory Society in nursing‐ and healthcare‐associated pneumonia patients. Methods We included 289 hospitalized nursing‐ and healthcare‐associated pneumonia patients between April 2016 and March 2017, and investigated the ability of PSI, A‐DROP, I‐ROAD and qSOFA to predict pneumonia‐related mortality. We also evaluated the associations among the risk factors for PDR pathogens, the detection ratio of PDR pathogens and pneumonia‐related mortality. Results The mortality rate of pneumonia during hospitalization was 6.9% (20/289). The area under the curve for pneumonia‐related mortality predicted using PSI, A‐DROP, I‐ROAD and qSOFA was 0.697 (95% confidence interval [CI] 0.59–0.80), 0.63 (95% CI 0.51–0.76), 0.61 (95% CI 0.52–0.70) and 0.701 (95% CI 0.59–0.81), respectively. In addition, higher areas under the curve were observed for pneumonia‐related mortality predicted according to a combination of PSI and hypoalbuminemia (<2.5 g/dL) (0.75, 95% CI 0.64–0.86), and qSOFA and hypoalbuminemia (0.74, 95% CI 0.62–0.86) than for PSI and qSOFA alone. No significant associations were observed among the risk factors for PDR pathogens, the detection ratios of PDR pathogens and pneumonia‐related mortality. Conclusions qSOFA and the combination of qSOFA and hypoalbuminemia might be simple and useful evaluation tools for predicting pneumonia‐related mortality in nursing‐ and healthcare‐associated pneumonia patients. Geriatr Gerontol Int 2019; 19: 177–183.

Utility of pneumonia severity assessment tools for mortality prediction in healthcare-associated pneumonia: a systematic review and meta-analysis

“…The characteristics of the included studies are shown in Table 2 . Among these 21 studies, five 6 , 13 , 18 , 30 , 36 and 16 4 , 7 , 14 , 19 , 31 – 35 , 37 – 43 were prospective and retrospective studies, respectively. The category of pneumonia was eight 7 , 19 , 31 , 33 , 36 , 38 , 39 , 42 , seven 13 , 18 , 32 , 34 , 35 , 41 , 43 , and six 4 , 6 , 14 , 30 , 37 , 40 for HCAP, NHCAP, and NHAP, respectively.…”

“…Among these 21 studies, five 6 , 13 , 18 , 30 , 36 and 16 4 , 7 , 14 , 19 , 31 – 35 , 37 – 43 were prospective and retrospective studies, respectively. The category of pneumonia was eight 7 , 19 , 31 , 33 , 36 , 38 , 39 , 42 , seven 13 , 18 , 32 , 34 , 35 , 41 , 43 , and six 4 , 6 , 14 , 30 , 37 , 40 for HCAP, NHCAP, and NHAP, respectively. Twelve 4 , 7 , 13 , 14 , 19 , 30 , 31 , 36 , 39 , 41 – 43 studies for PSI, 12 4 , 7 , 13 , 18 , 19 , 32 – 35 , 38 , 41 , 43 for A-DROP, seven 7 , 13 , 18 , 19 , 34 , 41 , 43 for I-ROAD, and 14 4 , 6 , 7 , 13 , …”

“…The category of pneumonia was eight 7 , 19 , 31 , 33 , 36 , 38 , 39 , 42 , seven 13 , 18 , 32 , 34 , 35 , 41 , 43 , and six 4 , 6 , 14 , 30 , 37 , 40 for HCAP, NHCAP, and NHAP, respectively. Twelve 4 , 7 , 13 , 14 , 19 , 30 , 31 , 36 , 39 , 41 – 43 studies for PSI, 12 4 , 7 , 13 , 18 , 19 , 32 – 35 , 38 , 41 , 43 for A-DROP, seven 7 , 13 , 18 , 19 , 34 , 41 , 43 for I-ROAD, and 14 4 , 6 , 7 , 13 , 14 , 19 , 30 , 31 , 36 , 37 , 39 – 42 for CURB-65 were included in this study.…”

“…Twelve 4 , 7 , 13 , 14 , 19 , 30 , 31 , 36 , 39 , 41 – 43 studies were included in the meta-analysis for the PSI score. Using a cut-off value of ≥ IV (moderate; n = 12), the pooled sensitivity, specificity, PLR, NLR, and DOR for mortality were calculated as 0.97 (0.94–0.98), 0.15 (0.10–0.21), 1.14 (1.08–1.20), 0.22 (0.12–0.38), and 5.09 (2.95–8.78), respectively (Table 3 ).…”

“…Furthermore, the influence of the general condition, such as “bedridden state” and “low serum albumin” as well as inflammatory biomarkers, such as “CRP level” and “neutrophil-to-lymphocyte ratio” has been shown for predicting mortality in elderly patients with pneumonia 47 , 48 . Therefore, these explain the low AUC value despite a large number of items, as the prognosis might be more strongly influenced by the ordinal general condition than the presence of comorbid diseases in these patients 43 . Similar to our results with low NLR, Chalmers et al reported that PSI might be superior for identifying low-risk patients with low NLR (0.2 for ≥ IV and 0.5 for ≥ V) in patients with CAP 49 , although the AUC value in our results was low compared with that of CAP (0.82 for ≥ IV, 0.81 for ≥ V).…”