Internal and Emergency Medicine

, Volume 6, Issue 5, pp 431–436

Performance of PSI, CURB-65, and SCAP scores in predicting the outcome of patients with community-acquired and healthcare-associated pneumonia

  • Marco Falcone
  • Salvatore Corrao
  • Mario Venditti
  • Pietro Serra
  • Giuseppe Licata
IM - Original

Abstract

The objective was to compare three score systems, pneumonia severity index (PSI), the Confusion-Urea-Respiratory Rate-Blood pressure-65 (CURB-65), and severe community-acquired pneumonia (SCAP), for prediction of the outcomes in a cohort of patients with community-acquired (CAP) and healthcare-associated pneumonia (HCAP). Large multi-center, prospective, observational study was conducted in 55 hospitals. HCAP patients were included in the high classes of CURB-65, PSI and SCAP scores have a mortality rate higher than that of CAP patients. HCAP patients included in the low class of the three severity rules have a significantly higher incidence of adverse events, including development of septic shock, transfer into an ICU, and death (p < 0.01). At multivariate Cox regression analysis, inclusion in the severe classes of PSI, CURB-65, or SCAP scores and receipt of an empirical therapy not adherent to international guidelines prove to be risk factors independently associated with poor outcome. PSI, CURB-65, and SCAP score have a good performance in patients with CAP but are less useful in patients with HCAP, especially in patients classified in the low-risk classes.

Keywords

Community-acquired pneumonia Healthcare-associated pneumonia PSI CURB 65 

References

  1. 1.
    Venditti M, Falcone M, Corrao S et al (2009) Comparison of the outcomes of patients hospitalized with community-acquired, health care-associated, and hospital-acquired pneumonia. Ann Intern Med 150:19–26PubMedGoogle Scholar
  2. 2.
    Zilberberg MD, Shorr AF, Micek ST et al (2008) Antimicrobial therapy escalation and hospital mortality among patients with health-care-associated pneumonia: a single-center experience. Chest 134:963–968PubMedCrossRefGoogle Scholar
  3. 3.
    Shorr AF, Zilberberg MD, Micek ST, Kollef MH (2008) Prediction of infection due to antibiotic-resistant bacteria by select risk factors for health care-associated pneumonia. Arch Intern Med 168:2205–2210PubMedCrossRefGoogle Scholar
  4. 4.
    Fine MJ, Auble TE, Yealy DM et al (1997) A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med 336:243–250PubMedCrossRefGoogle Scholar
  5. 5.
    Lim WS, van der Eerden MM, Laing R et al (2003) Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 58:377–382PubMedCrossRefGoogle Scholar
  6. 6.
    Espana PP, Capelastegui A, Gorordo I et al (2006) Development and validation of a clinical prediction rule for severe community-acquired pneumonia. Am J Respir Crit Care Med 174:1249–1256PubMedCrossRefGoogle Scholar
  7. 7.
    Shindo Y, Sato S, Maruyama E et al (2008) Comparison of severity scoring systems A-DROP and CURB-65 for community-acquired pneumonia. Respirology 13:731–735PubMedCrossRefGoogle Scholar
  8. 8.
    Mandell LA, Wunderink RG, Anzueto A et al (2007) Infectious Diseases Society of America. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 44(Suppl 2):S27–S72PubMedCrossRefGoogle Scholar
  9. 9.
    American Thoracic Society, Infectious Diseases Society of America (2005) Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 171:388–416CrossRefGoogle Scholar
  10. 10.
    Micek ST, Kollef KE, Reichley RM et al (2007) Health care-associated pneumonia and community-acquired pneumonia: a single-center experience. Antimicrob Agents Chemother 51:3568–3573PubMedCrossRefGoogle Scholar
  11. 11.
    Shindo Y, Sato S, Maruyama E et al (2009) Health-care-associated pneumonia among hospitalized patients in a Japanese community hospital. Chest 135:633–640PubMedCrossRefGoogle Scholar
  12. 12.
    Falcone M, Venditti M, Corrao S, Serra P for the SIMI (2011) Role of multidrug-resistant pathogens in health care-associated pneumonia. Lancet Infect Dis 11:12–13Google Scholar

Copyright information

© SIMI 2011

Authors and Affiliations

  • Marco Falcone
    • 1
  • Salvatore Corrao
    • 2
  • Mario Venditti
    • 1
  • Pietro Serra
    • 1
  • Giuseppe Licata
    • 2
  1. 1.Department of Public Health and Infectious Diseases, Policlinico Umberto IUniversity of Rome “La Sapienza”RomeItaly
  2. 2.Department of Internal MedicineUniversity of PalermoPalermoItaly

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