A Prospective Study of Presepsin as an Indicator of the Severity of Community-Acquired Pneumonia in Emergency Departments: Comparison with Pneumonia Severity Index and CURB-65 Scores

2019 ◽  
Vol 50 (4) ◽  
pp. 364-369 ◽  
Author(s):  
Ji Yeon Ham ◽  
Kyung Eun Song
Keyword(s):  
Prospective Study ◽  
Point Of Care ◽  
Pneumonia Severity Index ◽  
Biological Marker ◽  
Severity Index ◽  
Community Acquired Pneumonia ◽  
Pneumonia Severity ◽  
Point Of Care Test ◽  
Risk Patients ◽  
A Prospective Study

Abstract Despite widely used severity indices such as the pneumonia severity index (PSI) and CURB-65, a rapid, easy-to-detect biological marker is required for assessment of community-acquired pneumonia (CAP) severity. We aimed to investigate the ability of presepsin to differentiate between high- and low-risk patients, categorized according to PSI and CURB-65 scores. This prospective study was performed in an emergency department (ED) with 90 CAP patients. Whole blood presepsin levels were measured with a point-of-care test instrument. Using PSI and CURB-65 scores, we classified patients into outpatient (low-score group of PSI and CURB-65) and inpatient (high-score group of PSI and CURB-65) management groups. Presepsin levels were significantly higher in CAP patients with the high-score groups compared to the corresponding low-score groups. Presepsin correlated well with low- and high-score PSI (ROC AUC: presepsin, 0.726; PCT, 0.614; CRP, 0.544) and CURB-65 groups (ROC AUC: presepsin, 0.669; PCT, 0.645; CRP, 0.602). Presepsin is a valuable biomarker for assessing and classifying CAP severity.

Perbandingan Expanded Curb-65 Terhadap Curb-65 dan Psi Dalam Memprediksi Luaran Pasien Cap

2019 ◽  
Vol 4 (3) ◽  
pp. 608
Author(s):  
Suyastri Suyastri ◽  
Irvan Medison ◽  
Deddy Herman ◽  
Russilawati Russilawati
Keyword(s):  
Logistic Regression ◽  
Multivariate Analysis ◽  
Prospective Study ◽  
Pneumonia Severity Index ◽  
Severity Index ◽  
Accurate Method ◽  
P Value ◽  
Pneumonia Severity ◽  
Advantages And Disadvantages ◽  
Care Decision

<p><em>Tingkat keparahan CAP adalah poin penting pengambilan keputusan perawatan pasien. Beberapa metode telah digunakan untuk menilai tingkat keparahan pneumonia seperti Pneumonia Severity Index (PSI), CURB-65, SMART-COP dan Expanded CURB-65. Metode tersebut memiliki kelebihan dan kekurangan. Expanded CURB 65 diusulkan menjadi metode yang lebih akurat untuk mengevaluasi keparahan pneumonia dan memprediksi kematian pasien CAP. Tujuan penelitian ini memprediksi keakuratan Expanded CURB  65 dibandingkan CURB 65 dan PSI. Penelitian kohort prospektif pada pasien CAP yang dirawat di RSUP Dr. M.Djamil Padang dari April sampai Oktober 2019. Tingkat keparahan CAP pada pasien dinilai menggunakan PSI, CURB 65, Expanded CURB 65, kemudian hasilnya dievaluasi berdasarkan keparahan. Data dianalisis menggunakan regresi logistik dengan CI 95% dan nilai p &lt;0,05 dianggap signifikan. Hasil penelitian pada 90 pasien sebagian besar laki-laki usia 53 tahun dengan komorbiditas terbanyak keganasan. Uji Pearson Chi aquare menunjukkan tidak ada hubungan antara tingkat keparahan berdasarkan CURB 65 dan luaran pengobatan (CI 95%, nilai p = 0,104). Sementara, PSI dan Expanded CURB 65 memiliki hubungan yang signifikan antara tingkat keparahan dan luaran (CI 95%, p=0,081 dan CI 95%, p= 0,046, masing-masing). Analisis multivariat menemukan Expanded CURB 65 lebih akurat dalam memprediksi luaran pasien CAP rawat inap (kappa =0,108 dan AUC=0,422).</em></p><p><em><br /></em></p><p><em><em>Severity of CAP is very important for site care decision inpatients. Several methods have been used to assess the severity of pneumonia such as Pneumonia Severity Index (PSI), CURB-65, SMART-COP and Expanded CURB-65. Those methods have advantages and disadvantages. Expanded CURB 65 is proposed to be more accurate method for evaluating pneumonia severity and predicting mortality in CAP. The aim of this study was to investigate the accuracy of Expanded CURB 65 compare to CURB 65 and PSI. Cohort prospective study was conducted for CAP patients who were hospitalized at RSUP Dr. M.Djamil Padang from April to October 2019. Patients was assesed for severity using PSI, CURB 65, Expanded CURB 65, then we evaluated it’s outcome. The data were analyzed by logistic regression with CI 95% and p value &lt;0,05 considered as statistically significant. We found 90 patients that predominantly males with an average age of 53 years, and the most common comorbidity is malignancy. There was no relationship between pneumonia severity by CURB 65 and outcome (CI 95%, p=0.104). PSI and Expanded CURB 65 had significant relationship between severity and outcome (CI 95%, p=0.081and CI 95%, p=0.046, respectively). Multivariate analysis showed the expanded CURB 65 was more accurate for predicting the outcome of CAP inpatients (kappa=0.108 and AUC= 0.422).</em></em></p>

Soluble form of suppression of tumorigenicity-2 predicts clinical stability of inpatients with community-acquired pneumonia

2021 ◽  
pp. 153537022110271
Author(s):  
Yifeng Zeng ◽  
Mingshan Xue ◽  
Teng Zhang ◽  
Shixue Sun ◽  
Runpei Lin ◽  
...  
Keyword(s):  
Regression Model ◽  
Predictive Value ◽  
Cox Regression ◽  
Pneumonia Severity Index ◽  
Severity Index ◽  
Community Acquired Pneumonia ◽  
Risk Classification ◽  
Soluble Form ◽  
Pneumonia Severity ◽  
Clinical Stability

The soluble form of the suppression of tumorigenicity-2 (sST2) is a biomarker for risk classification and prognosis of heart failure, and its production and secretion in the alveolar epithelium are significantly correlated with the inflammation-inducing in pulmonary diseases. However, the predictive value of sST2 in pulmonary disease had not been widely studied. This study investigated the potential value in prognosis and risk classification of sST2 in patients with community-acquired pneumonia. Clinical data of ninety-three CAP inpatients were retrieved and their sST2 and other clinical indices were studied. Cox regression models were constructed to probe the sST2’s predictive value for patients’ restoring clinical stability and its additive effect on pneumonia severity index and CURB-65 scores. Patients who did not reach clinical stability within the defined time (30 days from hospitalization) have had significantly higher levels of sST2 at admission ( P <  0.05). In univariate and multivariate Cox regression analysis, a high sST2 level (≥72.8 ng/mL) was an independent reverse predictor of clinical stability ( P < 0.05). The Cox regression model combined with sST2 and CURB-65 (AUC: 0.96) provided a more accurate risk classification than CURB-65 (AUC:0.89) alone (NRI: 1.18, IDI: 0.16, P < 0.05). The Cox regression model combined with sST2 and pneumonia severity index (AUC: 0.96) also provided a more accurate risk classification than pneumonia severity index (AUC:0.93) alone (NRI: 0.06; IDI: 0.06, P < 0.05). sST2 at admission can be used as an independent early prognostic indicator for CAP patients. Moreover, it can improve the predictive power of CURB-65 and pneumonia severity index score.

scholarly journals Characterizing and Developing Strategies for the Treatment of Community-Acquired Pneumonia at a Community Hospital

2002 ◽  
Vol 9 (4) ◽  
pp. 247-252 ◽  
Author(s):  
Mark C Fok ◽  
Zahra Kanji ◽  
Rajesh Mainra ◽  
Michael Boldt
Keyword(s):  
Peer Group ◽  
Pneumonia Severity Index ◽  
Retrospective Chart Review ◽  
Severity Index ◽  
Early Discharge ◽  
Primary Diagnosis ◽  
Community Acquired Pneumonia ◽  
Pneumonia Severity ◽  
Pneumonia Severity Index Score ◽  
Step Down

BACKGROUND: Patients admitted to Lions Gate Hospital, North Vancouver, British Columbia, with a primary diagnosis of community-acquired pneumonia (CAP) have a mean length of stay (LOS) of 9.1 days compared with 7.9 days for peer group hospitals. This difference of 1.2 days results in an annual potential savings of 406 bed days and warranted an investigation into the management of CAP.OBJECTIVE: To characterize and provide recommendations for the management of CAP.METHODS: A retrospective chart review of patients admitted with a primary diagnosis of CAP between May 1, 2000 and August 31, 2000.RESULTS: Fifty-one patients were included in the study, with a mean LOS of 9.9 days and a median LOS of five days. Based on pneumonia severity index scores calculated for each patient, eight patients (16%) were admitted inappropriately. Initial empirical antibiotic choices were consistent with the Canadian CAP guidelines in 27 patients (53%), with inconsistencies arising mainly because cephalosporin or azithromycin monotherapy regimens were prescribed. Step-down from intravenous to oral antibiotics occurred in approximately 20 patients (39%). An additional 12 patients (24%) could have undergone step-down, and step-down was not applicable in 19 patients (37%). The potential annual cost avoidance from implementing admission criteria based on a pneumonia severity index score, applying step-down criteria and promoting early discharge criteria was estimated to be $220,000.CONCLUSIONS: Considerable variability exists in the treatment of CAP. A CAP preprinted order sheet was developed to address the issues identified in the present study and provide consistency in the management of CAP at Lions Gate Hospital.

Sign in / Sign up

Export Citation Format

Share Document