scholarly journals Stratified and prognostic value of admission lactate and severity scores in patients with community-acquired pneumonia in emergency department

Medicine ◽  
2019 ◽  
Vol 98 (41) ◽  
pp. e17479 ◽  
Author(s):  
Haijiang Zhou ◽  
Tianfei Lan ◽  
Shubin Guo
Keyword(s):  
Emergency Department ◽  
Prognostic Value ◽  
Community Acquired Pneumonia ◽  
Severity Scores

scholarly journals Prognostic Prediction Value of qSOFA, SOFA, and Admission Lactate in Septic Patients with Community-Acquired Pneumonia in Emergency Department

2020 ◽  
Vol 2020 ◽  
pp. 1-11 ◽  
Author(s):  
Haijiang Zhou ◽  
Tianfei Lan ◽  
Shubin Guo
Keyword(s):  
Emergency Department ◽  
Mechanical Ventilation ◽  
Mortality Rate ◽  
Community Acquired Pneumonia ◽  
Prediction Performance ◽  
Secondary Outcome ◽  
Icu Admission ◽  
Severity Scores ◽  
Prognostic Prediction ◽  
Vasopressor Use

Background. Community-acquired pneumonia (CAP) is a leading cause of sepsis and common presentation to emergency department (ED) with a high mortality rate. The prognostic prediction value of sequential organ failure assessment (SOFA) and quick SOFA (qSOFA) scores in CAP in ED has not been validated in detail. The aim of this research is to investigate the prognostic prediction value of SOFA, qSOFA, and admission lactate compared with that of other commonly used severity scores (CURB65, CRB65, and PSI) in septic patients with CAP in ED. Methods. Adult septic patients with CAP admitted between Jan. 2017 and Jan. 2019 with increased admission SOFA ≥ 2 from baseline were enrolled. The primary outcome was 28-day mortality. The secondary outcome included intensive care unit (ICU) admission, mechanical ventilation, and vasopressor use. Prognostic prediction performance of the parameters above was compared using receiver operating characteristic (ROC) curves. Kaplan–Meier survival curves were compared using optimal cutoff values of qSOFA and admission lactate. Results. Among the 336 enrolled septic patients with CAP, 89 patients died and 247 patients survived after 28-day follow-up. The CURB65, CRB65, PSI, SOFA, qSOFA, and admission lactate levels were statistically significantly higher in the death group (P<0.001). qSOFA and SOFA were superior and the combination of qSOFA + lactate and SOFA + lactate outperformed other combinations of severity score and admission lactate in predicting both primary and secondary outcomes. Patients with admission qSOFA < 2 or lactate ≤ 2 mmol/L showed significantly prolonged survival than those patients with qSOFA ≥ 2 or lactate > 2 mmol/L (log-rank χ2 = 59.825, P<0.001). The prognostic prediction performance of the combination of qSOFA and admission lactate was comparable to the full version of SOFA (AUROC 0.833 vs. 0.795, Z = 1.378, P=0.168 in predicting 28-day mortality; AUROC 0.868 vs. 0.895, Z = 1.022, P=0.307 in predicting ICU admission; AUROC 0.868 vs. 0.845, Z = 0.921, P=0.357 in predicting mechanical ventilation; AUROC 0.875 vs. 0.821, Z = 2.12, P=0.034 in predicting vasopressor use). Conclusion. qSOFA and SOFA were superior to CURB65, CRB65, and PSI in predicting 28-day mortality, ICU admission, mechanical ventilation, and vasopressor use for septic patients with CAP in ED. Admission qSOFA with lactate is a convenient and useful predictor. Admission qSOFA ≥ 2 or lactate > 2 mmol/L would be very helpful in discriminating high-risk patients with a higher mortality rate.

scholarly journals Role of Plasma Presepsin, Procalcitonin and C-reactive Protein Levels in Determining the Severity and Mortality of Community-Acquired Pneumonia in the Emergency Department

2020 ◽  
Keyword(s):  
Emergency Department ◽  
Community Acquired Pneumonia ◽  
C Reactive Protein ◽  
Pneumonia Severity ◽  
Protein Levels ◽  
Reactive Protein ◽  
Imaging Results ◽  
Severity Scores ◽  
Significant Difference

Objective: In this study, we aimed to explore the role of the plasma presepsin level in patients with community-acquired pneumonia during admission to the emergency department in assessing the diagnosis, severity, and prognosis of the disease. In addition, we wanted to investigate the relationship of presepsinin with procalcitonin, C-reactive protein and pneumonia severity scores. Methods: One hundred twenty-three patients over the age of 18 who presented with a diagnosis of pneumonia to the emergency department were included in the study. The vital signs, symptoms, examination findings, background information, laboratory results, and radiological imaging results of the patients were recorded. The 30-day mortality rates of the patients were determined. Results: A statistically significant difference was found between the presepsin levels of the patients diagnosed with pneumonia and those of healthy subjects (p < 0.05). The plasma presepsin levels of the patients who died (8.63 ± 6.46) were significantly higher than those of the patients who lived (5.82 ± 5.97) (p < 0.05). The plasma procalcitonin and C-reactive protein levels of the dead patients were significantly higher than those living (p < 0.05). A presepsin cut-off value of 3.3 ng/mL for 30-day mortality was established (AUROC, 0.65; specificity, 45%; sensitivity, 82%). Procalcitonin is the most successful biomarker in the determination of mortality (AUROC, 0.70). A significant correlation was available between presepsin and lactate, C-reactive protein and procalcitonin (p < 0.05). There was a significant correlation between the Pneumonia Severity Index values and presepsin levels (p < 0.001, r = 0.311). Conclusion: The plasma presepsin level can be utilized for diagnosing community-acquired pneumonia. Plasma presepsin, procalcitonin and C-reactive protein levels can be used to predict the severity and mortality of community-acquired pneumonia.

scholarly journals Prognostic performance of MR-pro-adrenomedullin in patients with community acquired pneumonia in the Emergency Department compared to clinical severity scores PSI and CURB

PLoS ONE ◽  
2017 ◽  
Vol 12 (11) ◽  
pp. e0187702 ◽  
Author(s):  
Jacopo Maria Legramante ◽  
Maria Mastropasqua ◽  
Beniamino Susi ◽  
Ottavia Porzio ◽  
Marta Mazza ◽  
...  
Keyword(s):  
Emergency Department ◽  
Community Acquired Pneumonia ◽  
Clinical Severity ◽  
Prognostic Performance ◽  
Severity Scores

Usefulness and prognostic value of biomarkers in patients with community-acquired pneumonia in the emergency department

2017 ◽  
Vol 148 (11) ◽  
pp. 501-510
Author(s):  
Agustín Julián-Jiménez ◽  
Juan González del Castillo ◽  
Francisco Javier Candel
Keyword(s):  
Emergency Department ◽  
Prognostic Value ◽  
Community Acquired Pneumonia

scholarly journals Community Acquired Pneumonia in the Emergency Department: value and limits of prognostic severity scores

2012 ◽  
Vol 8 (2) ◽  
pp. 44
Author(s):  
R. Ferrari ◽  
F. Tumietto ◽  
S. Tedeschi ◽  
F. Giostra ◽  
D. Agostinelli ◽  
...  
Keyword(s):  
Emergency Department ◽  
Community Acquired Pneumonia ◽  
Severity Scores

scholarly journals Predicting severe pneumonia in the emergency department: a global study of the Pediatric Emergency Research Networks (PERN)—study protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e041093
Author(s):  
Todd Adam Florin ◽  
Daniel Joseph Tancredi ◽  
Lilliam Ambroggio ◽  
Franz E Babl ◽  
Stuart R Dalziel ◽  
...  
Keyword(s):  
Emergency Department ◽  
Prediction Model ◽  
Severe Disease ◽  
Pediatric Emergency ◽  
Global Network ◽  
Clinical Prediction ◽  
Emergency Research ◽  
Research Networks ◽  
Clinical Prediction Model ◽  
Severity Scores

IntroductionPneumonia is a frequent and costly cause of emergency department (ED) visits and hospitalisations in children. There are no evidence-based, validated tools to assist physicians in management and disposition decisions for children presenting to the ED with community-acquired pneumonia (CAP). The objective of this study is to develop a clinical prediction model to accurately stratify children with CAP who are at risk for low, moderate and severe disease across a global network of EDs.Methods and analysisThis study is a prospective cohort study enrolling up to 4700 children with CAP at EDs at ~80 member sites of the Pediatric Emergency Research Networks (PERN; https://pern-global.com/). We will include children aged 3 months to <14 years with a clinical diagnosis of CAP. We will exclude children with hospital admissions within 7 days prior to the study visit, hospital-acquired pneumonias or chronic complex conditions. Clinical, laboratory and imaging data from the ED visit and hospitalisations within 7 days will be collected. A follow-up telephone or text survey will be completed 7–14 days after the visit. The primary outcome is a three-tier composite of disease severity. Ordinal logistic regression, assuming a partial proportional odds specification, and recursive partitioning will be used to develop the risk stratification models.Ethics and disseminationThis study will result in a clinical prediction model to accurately identify risk of severe disease on presentation to the ED. Ethics approval was obtained for all sites included in the study. Cincinnati Children’s Hospital Institutional Review Board (IRB) serves as the central IRB for most US sites. Informed consent will be obtained from all participants. Results will be disseminated through international conferences and peer-reviewed publications. This study overcomes limitations of prior pneumonia severity scores by allowing for broad generalisability of findings, which can be actively implemented after model development and validation.

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