Evaluation of pneumonia severity scoring systems in nursing and healthcare-associated pneumonia for predicting prognosis: A prospective, cohort study

被引:18
|
作者
Ito, Akihiro [1 ]
Ishida, Tadashi [1 ]
Tokumasu, Hironobu [2 ]
Yamazaki, Akio [1 ,3 ]
Washio, Yasuyoshi [1 ,4 ]
机构
[1] Kurashiki Cent Hosp, Ohara Healthcare Fdn, Dept Resp Med, Miwa 1-1-1, Kurashiki, Okayama 7108602, Japan
[2] Kurashiki Cent Hosp, Ohara Healthcare Fdn, Dept Clin Res Inst, Miwa 1-1-1, Kurashiki, Okayama 7108602, Japan
[3] Shiga Univ, Dept Resp Med, Med Sci Hosp, Tsukinowa Seta Cho, Otsu, Shiga 5202192, Japan
[4] Kyushu Univ, Grad Sch Med Sci, Res Inst Dis Chest, Higashiku Maidashi 3-1-1, Fukuoka, Fukuoka, Japan
关键词
Community-acquired pneumonia; Healthcare-associated pneumonia; Nursing and healthcare-associated pneumonia; Prognosis; Severity scoring system; COMMUNITY-ACQUIRED PNEUMONIA; INFECTIOUS-DISEASES-SOCIETY; GUIDELINES; MANAGEMENT; ADULTS; NHCAP;
D O I
10.1016/j.jiac.2019.11.001
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
The usefulness of existing pneumonia severity indices for predicting mortality in nursing and healthcare-associated pneumonia (NHCAP) is unclear. This study compared the usefulness of existing pneumonia severity indices for predicting mortality in NHCAP and community-acquired pneumonia (CAP). Consecutive hospitalized pneumonia patients including NHCAP and CAP patients were prospectively enrolled between October 2010 and November 2017. Admission pneumonia severity was assessed using CURB-65, Pneumonia Severity Index (PSI), A-DROP, Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) severe pneumonia criteria, and I-ROAD. The primary outcome was 30-day mortality. The discriminatory ability of each severity index was evaluated by receiver operating characteristic curve analysis. Overall, 828 patients had NHCAP, and 1330 patients had CAP. Thirty-day mortality was 12.8% and 5.6% in NHCAP and CAP patients, respectively. The area under the curve of PSI (0.717, 95% confidence interval 0.673-0.761) was the highest among all pneumonia severity indices, with significant differences compared with CURB-65 (0.651, 95% confidence interval 0.598-0.705, P = 0.02) and IDSA/ATS severe pneumonia criteria (0.659, 95% confidence interval 0.612-0.707, P = 0.03). The predictive abilities for 30-day mortality of the pneumonia severity indices, excluding PSI and I-ROAD, were significantly inferior for NHCAP than for CAP. PSI may be the most useful pneumonia severity score for predicting mortality in NHCAP. However, the predictive ability for mortality of each pneumonia severity score was worse for NHCAP than for CAP; therefore, the prognostic factors in NHCAP need to be identified for better management of NHCAP patients. (c) 2019 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
引用
收藏
页码:372 / 378
页数:7
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