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Prognostic score systems and community-acquired bacteraemic pneumococcal pneumonia
1Unit of Infectious Diseases, Dept of Medicine, Karolinska Institutet, Karolinska University Hospital, Solna, Sweden. carl.spindler@karolinska.se
The European Respiratory Journal
|June 2, 2006
Summary
Three pneumonia scoring systems accurately predict intensive care unit (ICU) need and mortality in bacteraemic pneumococcal pneumonia. While the Pneumonia Severity Index (PSI) showed highest sensitivity, CURB-65 proved simpler for clinical use.
Area of Science:
- Infectious Diseases
- Pulmonology
- Critical Care Medicine
Background:
- Bacteraemic pneumococcal pneumonia poses a significant mortality risk.
- Accurate prediction of intensive care unit (ICU) need and mortality is crucial for patient management.
- Existing scoring systems require evaluation for their efficacy in this specific patient population.
Purpose of the Study:
- To assess the accuracy of the Pneumonia Severity Index (PSI), CURB-65, and modified American Thoracic Society (mATS) rules.
- To determine the predictive value of these scores for ICU admission and mortality in invasive pneumococcal pneumonia.
- To identify independent prognostic factors for mortality in bacteraemic pneumococcal pneumonia.
Main Methods:
- Retrospective analysis of 114 adult patients with invasive pneumococcal pneumonia.
- Calculation of PSI, CURB-65, and mATS severity scores for all patients.
- Multiple regression analysis to determine the prognostic importance of variables and correlate severity scores with outcomes.
Main Results:
- All three scoring systems demonstrated utility in predicting ICU need and mortality.
- PSI, CURB-65 (score ≥2), and mATS (≥1 major or >1 minor risk factor) showed high sensitivity but moderate specificity.
- Mortality rate was 12%; severity score and treatment location (non-Infectious Diseases department) were independently associated with death.
Conclusions:
- PSI, CURB-65, and mATS are valuable tools for risk stratification in bacteraemic pneumococcal pneumonia.
- The Pneumonia Severity Index offers the highest sensitivity, while CURB-65 provides a simpler alternative for clinical application.
- Treatment in departments other than Infectious Diseases was linked to higher mortality, even after adjusting for disease severity.
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