Editorial Commentary: Community-acquired pneumonia, comparison of three mortality prediction scores in the emergency department
Successive measurements of global disease burden have documented that lower respiratory tract infections, including pneumonia, are among the top 10 causes of disability-adjusted life-years, and in 2019, pneumonia was the fourth cause of mortality for all ages. In Colombia, acute respiratory infections are the leading cause of mortality within the group of infectious diseases, 52.3% of the total reported between 2005 and 2019. Notably, the COVID-19 epidemic increased the impact of respiratory tract infections on the global disease burden, with estimates of 18 million excess deaths from January 2020 to December 2021 worldwide.
The assessment of an adult with pneumonia or suspected pneumonia demands the identification of the likelihood of death and hospitalization. Several scales have been constructed to estimate this probability to improve the predictive capacity of clinical evaluation. Among these scales, the CRB-65 and the CURB-65 standout, being the first recommended for use with clinical criteria and the second when laboratory data such as urea nitrogen are available. Additionally, for an individual with sepsis, there have been developed to predict mortality, such as SOFA (Sequential Organ Failure Assessment) and, more recently, the qSOFA(quick SOFA), which has an accurate prediction of mortality in this population.
Hincapié C et al. assessed the CURB-65, CRB-65 and SOFA scales to predict mortality and admission to the intensive care unit in adults with pneumonia in three cohorts of patients admitted in three medium- and high-complexity hospitals in the city of Medellin-Colombia. The study included 1110 patients with suspected pneumonia identified in the emergency department and followed up until discharge and death. The authors found that the highest discrimination capacity, measured by the ROC curve, for the outcome hospitalization in an intensive care unit was 0.61, 0.58, and 0.59 for the CURB-65, CRB-65, and SOFA, respectively. About mortality, the ROC found was 0.66, 0.63, and 0.63 for CURB-65, CRB65, and SOFA, respectively. The calibration was appropriate, that is, the ability to predict mortality and admission to the intensive care unit e for the three scales. Some readers have expressed their disagreement with the possible limited use of the scales, particularly the CURB-65 and the CRB-65, in the evaluation of an adult patient with pneumonia expressed by the authors.
- Streptococcus pneumoniae
- Organ Dysfunction Scores
- Emergency Service, Hospital
- Emergency Medical Services
- Anti-Bacterial Agents
Vos T, Lim SS, Abbafati C, Abbas KM, Abbasi M, Abbasifard M, et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet. 2020;396(10258):1204-22. https://doi.org/10.1016/S0140-6736(20)30925-9
Ministerio de Salud y Protección Social. Análisis de Situación de Salud, Colombia 2019. 2019.
Wang H, Paulson KR, Pease SA, Watson S, Comfort H, Zheng P, et al. Estimating excess mortality due to the COVID-19 pandemic: a systematic analysis of COVID-19-related mortality, 2020-21. The Lancet. 2022;399(10334):1513-36. https://doi.org/10.1016/S0140-6736(21)02796-3
Lim WS, van der Eerden MM, Laing R, Boersma WG, Karalus N, Town GI, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 2003;58(5):377-82. https://doi.org/10.1136/thorax.58.5.377 PMid:12728155 PMCid:PMC1746657
Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996;22(7):707-10.https://doi.org/10.1007/BF01709751 PMid:8844239
Serafim R, Gomes JA, Salluh J, Póvoa P. A Comparison of the Quick-SOFA and Systemic Inflammatory Response Syndrome Criteria for the Diagnosis of Sepsis and Prediction of Mortality: A Systematic Review and Meta-Analysis. Chest. 2018;153(3):646-55. https://doi.org/10.1016/j.chest.2017.12.015 PMid:29289687
Hincapié C, Ascuntar J, León A, Jaimes F. Community-acquired pneumonia: comparison of three mortality prediction scores in the emergency department. Colomb Med (Cali). 2021;52(4):e2044287.https://doi.org/10.25100/cm.v52i4.4287 PMid:35499040 PMCid:PMC9015018
Wipf JE, Lipsky BA, Hirschmann JV, Boyko EJ, Takasugi J, Peugeot RL, et al. Diagnosing pneumonia by physical examination: relevant or relic? Arch Intern Med. 1999;159(10):1082-7. https://doi.org/10.1001/archinte.159.10.1082 PMid:10335685
Metlay JP, Kapoor WN, Fine MJ. Does this patient have community-acquired pneumonia? Diagnosing pneumonia by history and physical examination. Jama. 1997;278(17):1440-5. https://doi.org/10.1001/jama.1997.03550170070035 PMid:9356004
Atamna A, Shiber S, Yassin M, Drescher MJ, Bishara J. The accuracy of a diagnosis of pneumonia in the emergency department. International Journal of Infectious Diseases. 2019;89:62-5. https://doi.org/10.1016/j.ijid.2019.08.027 PMid:31479761
Ticona JH, Zaccone VM, McFarlane IM. Community-Acquired Pneumonia: A Focused Review. Am J Med Case Rep. 2021;9(1):45-52. https://doi.org/10.12691/ajmcr-9-1-12 PMid:33313398 PMCid:PMC7723780
Asner SA, Desgranges F, Schrijver IT, Calandra T. Impact of the timeliness of antibiotic therapy on the outcome of patients with sepsis and septic shock. Journal of Infection. 2021;82(5):125-34.https://doi.org/10.1016/j.jinf.2021.03.003 PMid:33722641
Alba AC, Agoritsas T, Walsh M, Hanna S, Iorio A, Devereaux PJ, et al. Discrimination and Calibration of Clinical Prediction Models: Users' Guides to the Medical Literature. Jama. 2017;318(14):1377-84. https://doi.org/10.1001/jama.2017.12126 PMid:29049590
Kent P, Cancelliere C, Boyle E, Cassidy JD, Kongsted A. A conceptual framework for prognostic research. BMC Medical Research Methodology. 2020;20(1):172. https://doi.org/10.1186/s12874-020-01050-7 PMid:32600262 PMCid:PMC7325141
Narváez PO, Gomez-Duque S, Alarcon JE, Ramirez-Valbuena PC, Serrano-Mayorga CC, Lozada-Arcinegas J, et al. Invasive pneumococcal disease burden in hospitalized adults in Bogota, Colombia. BMC Infect Dis. 2021;21(1):1059. https://doi.org/10.1186/s12879-021-06769-2 PMid:34641809 PMCid:PMC8507327
Aujesky D, Auble TE, Yealy DM, Stone RA, Obrosky DS, Meehan TP, et al. Prospective comparison of three validated prediction rules for prognosis in community-acquired pneumonia. Am J Med. 2005;118(4):384-92. https://doi.org/10.1016/j.amjmed.2005.01.006 PMid:15808136
Metlay JP, Waterer GW, Long AC, Anzueto A, Brozek J, Crothers K, et al. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67. https://doi.org/10.1164/rccm.201908-1581ST PMid:31573350 PMCid:PMC6812437
National Institute for Health and Care Excellence. Pneumonia (communityacquired): antimicrobial prescribing. NICE guideline . 2022.
Copyright (c) 2022 Universidad del Valle
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The copy rights of the articles published in Colombia Médica belong to the Universidad del Valle. The contents of the articles that appear in the Journal are exclusively the responsibility of the authors and do not necessarily reflect the opinions of the Editorial Committee of the Journal. It is allowed to reproduce the material published in Colombia Médica without prior authorization for non-commercial use