scholarly journals NEWS2 Versus PSI in CAP

2021 ◽  
Author(s):  
Neelam Kumari ◽  
Nausheen Saifullah ◽  
Naseem Ahmed ◽  
Saira Jafri ◽  
Aziz Barry ◽  
...  
Keyword(s):  
Clinical Laboratory ◽  
Pneumonia Severity Index ◽  
Severity Index ◽  
Community Acquired Pneumonia ◽  
Mortality Prediction ◽  
Early Warning Score ◽  
Sensitivity Analyses ◽  
Cross Sectional ◽  
Prediction Of Mortality ◽  
The Uk

Abstract Background: In the UK, National Early Warning Score (NEWS2) has been in frequent use to precisely categorize patients according to severity and as an aid in deciding the level of management. NEWS2 is an excellent tool that does not need any laboratory investigation to mark. With Pneumonia Severity Index (PSI), however, many variables are taken into account i.e. clinical, laboratory and imaging to score the patients into classes of severity. Our aim is to compare NEWS2 with PSI to foresee in-hospital mortality in patients with community acquired pneumonia (CAP).Methods: A cross-sectional analytical study was conducted on a sample of 116 Pakistanis presenting with CAP. We performed statistical analyses on SPSS version 22.0 and observed frequencies of various categorized variables. ROC curve for estimating AUC and sensitivity analyses were performed to evaluate predictive validity of each severity score in relation to in-hospital outcome.Results: There were 45 (38.8%) mortalities during the hospital stay. Sensitivity of NEWS2 in terms of mortality prediction was 97.8% but specificity was only 15.5% whereas PSI showed worse sensitivity (68.9%) but better specificity (50.7%).Conclusion: NEWS2 is much more sensitive than specific for prediction of mortality among CAP patients as compared to PSI.

scholarly journals Hospital Admission Patterns in Adult Patients with Community-Acquired Pneumonia Who Received Ceftriaxone and a Macrolide by Disease Severity across United States Hospitals

Antibiotics ◽  
2020 ◽  
Vol 9 (9) ◽  
pp. 577 ◽  
Author(s):  
Thomas P. Lodise ◽  
Hoa Van Le ◽  
Kenneth LaPensee
Keyword(s):  
Length Of Stay ◽  
Healthcare Delivery ◽  
Pneumonia Severity Index ◽  
Severity Index ◽  
Primary Diagnosis ◽  
Hospital Length ◽  
Community Acquired Pneumonia ◽  
Hospital Length Of Stay ◽  
Cross Sectional ◽  
Risk Class

(1) Objective: There are limited data regarding community-acquired pneumonia (CAP) admissions patterns in US hospitals. Current expert CAP guidelines advocate for outpatient treatment or an abbreviated hospital stay for CAP patients in pneumonia severity index (PSI) risk classes I–III (low risk); however, the extent of compliance with this recommendation is unclear. This study sought to estimate the proportion of admissions among CAP patients who received ceftriaxone and macrolide therapy, one of the most commonly prescribed guideline-concordant CAP regimens, by PSI risk class and Charlson comorbidity index (CCI) score. (2) Methods: A retrospective cross-sectional study of patients in the Vizient® (MedAssets, Irving, Texas) database between 2012 and 2015 was performed. Patients were included if they were aged ≥ 18 years, had a primary diagnosis for CAP, and received ceftriaxone and a macrolide on hospital day 1 or 2. Baseline demographics and admitting diagnoses were used to calculate the PSI score. Patients in the final study population were grouped into categories by their PSI risk class and CCI score. Hospital length of stay, 30-day mortality rates, and 30-day CAP-related readmissions were calculated across resulting PSI–CCI strata. (3) Results: Overall, 32,917 patients met the study criteria. Approximately 70% patients were in PSI risk classes I–III and length of stay ranged between 4.9 and 6.2 days, based on CCI score. The 30-day mortality rate was <0.5% and <1.4% in patients with PSI risk classes I and II, respectively. (4) Conclusions: Over two-thirds of hospitalized patients with CAP who received ceftriaxone and a macrolide were in PSI risk classes I–III. Although the findings should be interpreted with caution, they suggest that there is a potential opportunity to improve the efficiency of healthcare delivery for CAP patients by shifting inpatient care to the outpatient setting in appropriate patients.

scholarly journals PNEUMONIA SEVERITY INDEX (PSI)

2016 ◽  
Vol 23 (12) ◽  
pp. 1455-1461
Author(s):  
Maqsood Ahmed Khan ◽  
Syed Baqir Shyum Naqvi ◽  
Shazia Alam ◽  
Yousra Shafiq ◽  
Mudassar Hassan ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Age Distribution ◽  
Pneumonia Severity Index ◽  
Severity Index ◽  
Cross Sectional Study ◽  
Community Acquired Pneumonia ◽  
Class Iii ◽  
Cross Sectional ◽  
Pneumonia Severity ◽  
Study Results

Morbidity and mortality due to community acquired pneumonia has beenincreased in our country. Children and old age patients are mostly effected due to communityacquired pneumonia Study design: Cross sectional study. Setting: Patients hospitalized forCommunity acquired pneumonia in four different hospitals located at different areas werestudied. Period: Three years period from August 2011 to August 2014. Objectives: To assessdemographic profile, pneumonia severity index and length of stay of community acquiredpneumonia patients hospitalized at different hospitals in Karachi. Method: 800 patients bothmale and females patients were included in this study. Results: It was found that 480 (60%)were males and 320 (40%) were females, males were significantly more frequent (c2=0.48,p˂0.05) than the females patients. There was a significance difference in numbers of differentage group patients. According to the age distribution, there were 222(27.75%) from 1-5 years,which was the highest among the patients and there were 44(5.5%) from 81-90 years of agegroup patients, which was least among the different age group patients. According to thecomorbidity most of the patients were found without comorbidity there were 456(57%) patientspossess no comorbidity. Patients with comorbidity were 344(43%), and comorbidity was foundin patients with hypertension were 131(16.4%) and patients with diabetes were 105(13.1%) thesewere the two most commonly comorbidity disease found. According to the socioeconomicstatus (SES) status there were 482(60.25%) patients from lower SES class, 270(33.8%) patientfrom middle SES class and 54(6.8%) patients from high Socioeconomic class. patient with lowSES were much higher at hospital C and hospital D.(c2=127.88,p˂0.05). CAP is more frequentin married patients, married patients status were much higher at hospital C and hospital D(c2=60.31, p˂0.05). According to the PSI segregation there were 424(53%) patients from PSIclass I, 168(21%) were from PSI class II, 128(16%) patients were from PSI class III, 44(5.5%)were from class IV and 36(4.5%) were from PSI class V. Mean length of stay (LOS) was greaterat hospital C and D as compare to other two hospitals. Conclusion: CAP is frequent amongmales, low socio-economic, hypertensive individuals and patients from 1-5 years of age. Theshortest mean length found was 3.6days at hospital A and the longest mean length of stayfound was 7.6 days at hospital D.

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 Plasma Soluble Urokinase-Type Plasminogen Activator Receptor Level as a Predictor of the Severity of Community-Acquired Pneumonia

2019 ◽  
Vol 16 (6) ◽  
pp. 1035 ◽  
Author(s):  
Ping-Kun Tsai ◽  
Shih-Ming Tsao ◽  
Wei-En Yang ◽  
Chao-Bin Yeh ◽  
Hsiang-Ling Wang ◽  
...  
Keyword(s):  
Plasminogen Activator ◽  
Pneumonia Severity Index ◽  
Severity Index ◽  
Community Acquired Pneumonia ◽  
Enzyme Linked Immunosorbent Assay ◽  
Raw 264.7 Macrophages ◽  
Type Plasminogen Activator ◽  
Upar Expression ◽  
Urokinase Type Plasminogen Activator ◽  
Plasminogen Activator Receptor

The urokinase-type plasminogen activator receptor (uPAR) mediates various cellular activities and is involved in proteolysis, angiogenesis, and inflammation. The objective of this study was to investigate the association between soluble uPAR (suPAR) levels and community-acquired pneumonia (CAP) severity. A commercial enzyme-linked immunosorbent assay (ELISA) was performed to measure the plasma suPAR levels in 67 healthy controls and 75 patients with CAP. Our results revealed that plasma suPAR levels were significantly elevated in patients with CAP compared with the controls, and antibiotic treatment was effective in reducing suPAR levels. The plasma suPAR levels were correlated with the severity of CAP based on the pneumonia severity index (PSI) scores. Furthermore, lipopolysaccharide (LPS)-stimulation significantly increased uPAR expression in RAW 264.7 macrophages. In conclusion, plasma suPAR levels may play a role in the clinical assessment of CAP severity; these findings may provide information on new targets for treatment of CAP.

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.

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