scholarly journals Validity of Pneumonia Severity Assessment Scores in Africa and South Asia: A Systematic Review and Meta-Analysis

Healthcare ◽  
2021 ◽  
Vol 9 (9) ◽  
pp. 1202
Author(s):  
Sarah Khalid Al Hussain ◽  
Amanj Kurdi ◽  
Nouf Abutheraa ◽  
Asma AlDawsari ◽  
Jacqueline Sneddon ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Respiratory Rate ◽  
South Asia ◽  
Meta Analysis ◽  
Pneumonia Severity Index ◽  
Severity Index ◽  
Cochrane Central Register ◽  
Severity Assessment ◽  
Pneumonia Severity ◽  
Assessment Scores

Background: Although community-acquired pneumonia (CAP) severity assessment scores are widely used, their validity in low- and middle-income countries (LMICs) is not well defined. We aimed to investigate the validity and performance of the existing scores among adults in LMICs (Africa and South Asia). Methods: Medline, Embase, Cochrane Central Register of Controlled Trials, Scopus and Web of Science were searched to 21 May 2020. Studies evaluating a pneumonia severity score/tool among adults in these countries were included. A bivariate random-effects meta-analysis was performed to examine the scores’ performance in predicting mortality. Results: Of 9900 records, 11 studies were eligible, covering 12 tools. Only CURB-65 (Confusion, Urea, Respiratory Rate, Blood Pressure, Age ≥ 65 years) and CRB-65 (Confusion, Respiratory Rate, Blood Pressure, Age ≥ 65 years) were included in the meta-analysis. Both scores were effective in predicting mortality risk. Performance characteristics (with 95% Confidence Interval (CI)) at high (CURB-65 ≥ 3, CRB-65 ≥ 3) and intermediate-risk (CURB-65 ≥ 2, CRB-65 ≥ 1) cut-offs were as follows: pooled sensitivity, for CURB-65, 0.70 (95% CI = 0.25–0.94) and 0.96 (95% CI = 0.49–1.00), and for CRB-65, 0.09 (95% CI = 0.01–0.48) and 0.93 (95% CI = 0.50–0.99); pooled specificity, for CURB-65, 0.90 (95% CI = 0.73–0.96) and 0.64 (95% CI = 0.45–0.79), and for CRB-65, 0.99 (95% CI = 0.95–1.00) and 0.43 (95% CI = 0.24–0.64). Conclusions: CURB-65 and CRB-65 appear to be valid for predicting mortality in LMICs. CRB-65 may be employed where urea levels are unavailable. There is a lack of robust evidence regarding other scores, including the Pneumonia Severity Index (PSI).

scholarly journals Evaluation of dynamic thiol/disulfide homeostasis in adult patients with community-acquired pneumonia

2018 ◽  
Vol 26 (6) ◽  
pp. 343-350 ◽  
Author(s):  
Alp Şener ◽  
Gülhan Kurtoğlu Çelik ◽  
Ayhan Özhasenekler ◽  
Şervan Gökhan ◽  
Fatih Tanrıverdi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Respiratory Rate ◽  
Age Groups ◽  
Pneumonia Severity Index ◽  
Severity Index ◽  
Community Acquired Pneumonia ◽  
Mortality And Morbidity ◽  
Total Thiol ◽  
Diagnosis And Prognosis ◽  
Significant Difference

Background: Community-acquired pneumonia is an important cause of mortality and morbidity in all age groups. Oxidant and antioxidant mechanisms play an important role in the pathogenesis and mortality of community-acquired pneumonia. Objectives: In this study, the role of thiol/disulfide homeostasis in the diagnosis and prognosis of community-acquired pneumonia was investigated. Methods: This was a prospective, controlled, observational study involving 73 community-acquired pneumonia patients and 68 healthy volunteers. Results: The native thiol and total thiol, which are thiol/disulfide homeostasis components, were significantly lower in the community-acquired pneumonia group. It was also found that the native thiol was lower in the high-risk community-acquired pneumonia group and that the native thiol and total thiol were associated with the Pneumonia Severity Index, CRB65 (confusion, respiratory rate, blood pressure, ⩾65 years old), and CURB65 (confusion, uremia, respiratory rate, blood pressure, ⩾65 years old) scores. The thiol compound levels were also associated with the C-reactive protein and procalcitonin levels. However, there was no significant difference between the survivors and non-survivors in terms of the thiol/disulfide homeostasis parameters. Conclusion: This study demonstrated the important role that oxidative stress plays in the pathogenesis of community-acquired pneumonia. The thiol/disulfide homeostasis biomarkers especially the native thiol and index-1 levels were significantly lower in patients with community-acquired pneumonia. Further studies are needed to investigate the diagnostic and prognostic value of thiol/disulfide homeostasis parameters in community-acquired pneumonia.

scholarly journals The role of qSOFA score and biomarkers in assessing severity of community-acquired pneumonia in adults

2021 ◽  
Vol 29 (1) ◽  
pp. 65-75
Author(s):  
Raluca-Elena Tripon ◽  
Victor Cristea ◽  
Mihaela-Sorina Lupse
Keyword(s):  
Adverse Outcome ◽  
Pneumonia Severity Index ◽  
Severity Index ◽  
Community Acquired Pneumonia ◽  
Pneumonia Severity ◽  
Assessment Scores ◽  
Reactive Protein ◽  
Severity Scores ◽  
The Mean ◽  
Qsofa Score

Abstract Introduction: Community-acquired pneumonia (CAP) is the primary cause of severe sepsis. Severity assessment scores have been created, in order to help physicians decide the proper management of CAP. The purpose of this study was to examine the correlations between different CAP severity scores, including qSOFA, several biomarkers and their predictive value in the 30 day follow-up period, regarding adverse outcome. Materials and methods: One hundred and thirty nine adult patients with CAP, admitted in the Teaching Hospital of Infectious Diseases, Cluj-Napoca, Romania from December 2015 to February 2017, were enrolled in this study. Pneumonia Severity Index (PSI), CURB-65, SMART-COP and the qSOFA scores were calculated at admittance. Also, C-reactive protein (CRP), procalcitonin (PCT) and albumin levels were used to determine severity. Results: The mean PSI of all patients was 93.30±41.135 points, for CURB-65 it was 1.91±0.928 points, for SMART-COP it was 1.69±1.937 points. The mean qSOFA was 1.06±0.522 points, 21 (14.9%) were at high risk of in-hospital mortality. In the group of patients with qSOFA of ≥2, all pneumonia severity scores and all biomarkers tested were higher than those with scores <2. We found significant correlations between biomarkers and severity scores, but none regarding adverse outcome. Conclusion: The qSOFA score is easier to use and it is able to accurately evaluate the severity of CAP, similar to other scores. Biomarkers are useful in determining the severity of the CAP. Several studies are needed to assess the prediction of these biomarkers and severity scores in pneumonia regarding adverse outcome.

scholarly journals Accuracy Between CURB-65 Score and PSI in Determining The Prognosis of Community-Acquired Pneumonia Patients at H. Adam Malik General Hospital, Medan

2021 ◽  
Vol 1 (3) ◽  
pp. 174-181
Author(s):  
Fransisco Sentosa Pakpahan ◽  
Syamsul Bihar ◽  
Fajrinur Syarani ◽  
Putri Chairani Eyanoer
Keyword(s):  
General Hospital ◽  
Medical Records ◽  
Pneumonia Severity Index ◽  
Severity Index ◽  
Descriptive Study ◽  
Community Acquired Pneumonia ◽  
Initial Assessment ◽  
Pneumonia Severity ◽  
Assessment Scores ◽  
Admission Data

Background: Community-Acquired Pneumonia (CAP) is an important problem associated with morbidity and mortality. An accurate initial assessment is required before starting management of a CAP patient to determine the prognosis of the patient as early as possible. The CURB-65 score and PSI (Pneumonia Severity Index) are initial assessment scores that can be used. This study aimed to compare the accuracy between the CURB-65 score and the PSI in determining the prognosis in CAP patients at H. Adam Malik General Hospital Medan. Method: A descriptive study was conducted on 76 patients diagnosed with CAP. Each patient was assessed for their CURB-65 score, PSI class and mortality within 30 days of admission. Data were collected through patient medical records diagnosed CAP in 2018 and performed statistical analysis using 2x2 tables. Results: The CURB-65 ≥3 score showed accuracy (71.0%), sensitivity (53.8%), and specificity (89,2%). The CURB-65 ≥ 2 score showed accuracy (75.0%), sensitivity (82.1%), and specificity (67.6%).  Meanwhile, the Class IV-V PSI showed accuracy (77.6%), sensitivity (87.2%) and specificity (67.6%). Conclusion: The accuracy of the PSI is higher when compared to the CURB-65 score in determining the prognosis of CAP patients at H. Adam Malik General Hospital Medan. Although PSI is more accurate, CURB-65 is simpler, easier and less expensive to use

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.

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