Severe Community-Acquired Pneumonia: Validation of the Infectious Diseases Society of America/American Thoracic Society Guidelines to Predict an Intensive Care Unit Admission
Severe Community-Acquired Pneumonia: Validation of the Infectious Diseases Society of America/American Thoracic Society Guidelines to Predict an Intensive Care Unit Admission
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DOI：
10.1086/596307
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发表时间：
2009-02-15
影响因子：
11.8
通讯作者：
Torres, Antoni
中科院分区：
文献类型：
--
作者：
Liapikou, Adamantia;Ferrer, Miquel;Torres, Antoni
背景最近美国传染病学会/美国胸科学会成人社区获得性肺炎（CAP）管理指南定义了一个预测规则，用于识别重度CAP患者，以确定是否需要入住重症监护病房（ICU）。我们在临床上验证了这一规则。我们分析了7年内连续住院患者的2102例CAP发作。预测规则由2个主要严重程度标准（脓毒性休克和有创机械通气）中的至少1个或9个次要严重程度标准中的至少3个组成。我们评估了预测规则与ICU入院率和死亡率的关系。入住ICU的患者中共有235例CAP发作（11%），而预测规则将2102例发作中的397例（19%）确定为重度CAP。1804例（86%）事件（kappa系数，0.45）的预测规则和ICU入院决策一致，敏感性为71%，特异性为88%，与2001年美国胸科学会指南（敏感性，66%;特异性，90%）预测ICU入院相似。与2001年美国胸科学会指南相比，重度CAP标准在预测住院死亡率方面具有更高的敏感性（58% vs. 46%）和相似的特异性（88% vs. 90%）。有创机械通气是ICU入院的主要决定因素，其次是感染性休克。在缺乏主要标准的情况下，ICU入院与轻微严重程度标准患者的生存无关。与之前的美国胸科学会指南相比，识别严重CAP的预测规则对于ICU入院是准确的，并提高了死亡率的预测。仅根据轻微严重程度标准是否需要ICU入院尚不确定，值得进一步研究。
Background. The recent Infectious Disease Society of America/American Thoracic Society guidelines for the management of community-acquired pneumonia (CAP) in adults defined a predictive rule to identify patients with severe CAP to determine the need for intensive care unit (ICU) admission. We clinically validated this rule.Methods. We analyzed 2102 episodes of CAP in consecutively hospitalized patients over a 7-year period. The predictive rule consists of at least 1 of 2 major severity criteria (septic shock and invasive mechanical ventilation) or at least 3 of 9 minor severity criteria. We assessed the association of the predictive rule with ICU admission and mortality.Results. A total of 235 episodes of CAP (11%) occurred in patients who were admitted to the ICU, whereas the predictive rule identified 397 (19%) of 2102 episodes as severe CAP. The predictive rule and the decision for ICU admission agreed in 1804 (86%) of the episodes (kappa coefficient, 0.45), with a sensitivity of 71% and a specificity of 88%, similar to the 2001 American Thoracic Society guidelines (sensitivity, 66%; specificity, 90%) in predicting ICU admission. Severe CAP criteria had higher sensitivity (58% vs. 46%) and similar specificity (88% vs. 90%), compared with the 2001 American Thoracic Society guidelines in predicting hospital mortality. Invasive mechanical ventilation was the main determinant for ICU admission, followed by septic shock. In the absence of major criteria, ICU admission was not related to survival of patients with minor severity criteria.Conclusions. The predictive rule to identify severe CAP is accurate for ICU admission and improved the prediction of mortality, compared with the previous American Thoracic Society guidelines. The need for ICU admission derived from minor severity criteria alone is uncertain and deserves further investigation.