Improving the 2007 Infectious Disease Society of America/American Thoracic Society severe community-acquired pneumonia criteria to predict intensive care unit admission
Por:
Sibila, O, Meduri, GU, Mortensen, EM, Anzueto, A, Laserna, E, Fernandez, JF, El-Sohl, A, Restrepo, MI
Publicada:
1 jun 2013
Resumen:
Purpose: To improve 2007 Infectious Disease Society of America/American Thoracic Society (IDSA/ATS) severity criteria to predict intensive care unit (ICU) admission in patients hospitalized with pneumonia.
Methods: A composite score that included the 2007 IDSA/ATS criteria for severe pneumonia and additional significant variables identified by recent publications was tested in patients hospitalized with community-acquired pneumonia.
Results: Among 787 patients hospitalized with community-acquired pneumonia, 156 (19.8%) required admission to the ICU. We identified one major criterion (arterial pH <7.30), and 4 minor criteria (tachycardia >125 bpm, arterial pH 7.30-7.34, sodium <130 mEq/L and glucose >250 mg/dL) to be associated with ICU admission. Adding arterial pH <7.30 to the 2 2007 IDSA/ATS major criteria increased sensitivity from 61.5% to 71.8% and area under the curve (AUC) from 0.80 to 0.86. Adding in sequence the four minor criteria to the 2007 IDSA/ATS minor criteria, increased sensitivity from 41.7% to 53.8%, and AUC from 0.65 to 0.69. In the new composite score, combining 1 of 3 major criteria with 3 of 12 minor criteria showed a sensitivity of 92.9% and an AUC of 0.88.
Conclusion: The addition of arterial pH <7.30 to the 2007 IDSA/ATS major criteria improves sensitivity and AUC to identify patients who will require ICU care. Published by Elsevier Inc.
Filiaciones:
Sibila, O:
Univ Texas Hlth Sci Ctr San Antonio, San Antonio, TX 78229 USA
Hosp Santa Creu & Sant Pau, Serv Pneumol, Barcelona, Spain
Meduri, GU:
Memphis VA Med Ctr, Memphis, TN USA
Mortensen, EM:
VA North Texas Hlth Care Syst, Bonham, TX USA
Univ Texas Southwestern Med Ctr, Dallas, TX USA
Anzueto, A:
Univ Texas Hlth Sci Ctr San Antonio, San Antonio, TX 78229 USA
VA South Texas Hlth Care Syst, San Antonio Texas, TX USA
Laserna, E:
Univ Texas Hlth Sci Ctr San Antonio, San Antonio, TX 78229 USA
Hosp Comarcal Mollet, Mollet Del Valles, Spain
Fernandez, JF:
Univ Texas Hlth Sci Ctr San Antonio, San Antonio, TX 78229 USA
VA South Texas Hlth Care Syst, San Antonio Texas, TX USA
El-Sohl, A:
VA Western New York Hlth Care Syst, New York, NY USA
Restrepo, MI:
Univ Texas Hlth Sci Ctr San Antonio, San Antonio, TX 78229 USA
VA South Texas Hlth Care Syst, San Antonio Texas, TX USA
Vet Evidence Based Res Disseminat & Implementat C, San Antonio Texas, TX USA
Green Accepted
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