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Prognostic value of blood pressure drops during the first 24 h after hospital admission for risk stratification of community-acquired pneumonia: a retrospective cohort study

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Abstract

Objectives

Current risk stratification in community-acquired pneumonia (CAP) does not incorporate the dynamic nature of CAP evolution. Study aim was to evaluate the predictive value of early blood pressure (BP) drop and its consideration within the CRB-65 score.

Methods

We performed a retrospective cohort study including consecutive adult hospitalized CAP patients 2013–2014 without documented treatment limitations or direct ICU admission. The CRB-65 score was calculated initially and re-calculated including any BP below the threshold (BP drop) within the first 24 h (CRB-65[BP24]). The primary endpoint was need for mechanical ventilation or vasopressors (MVVS) occurring after 24 h. Prognostic values were evaluated by uni- and multivariate and ROC curve analyses.

Results

28/294 patients (9.5%) met the primary endpoint. Only 3 (11%) of them showed an initial BP of < 90 mmHg systolic or ≤ 60 mmHg diastolic, but 21 (75%) developed a BP drop within the first 24 h. 24/178 (13%) with and only 4/116 (3%) without any low BP during the first 24 h needed MVVS (p = 0.004). After multivariate analysis, the predictive value of BP drop was independent of other score parameters and biomarkers (all p < 0.01). In ROC analysis, the new CRB-65(BP24) showed a better prediction than the CRB-65 score (AUC 0.69 vs. 0.62, p = 0.04). 7/13 patients (54%) with MVVS despite an admission CRB-65 of 0 or 1 showed a BP drop.

Conclusions

In the evaluated cohort, BP drop within the first 24 h was significantly associated with more need for MVVS in CAP, and its consideration improved the prognostic value of the CRB-65 score.

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There was no external funding for the presented work.

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Authors and Affiliations

  1. Division of Pulmonology, Medical Department I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany

    Bernhard Schulte-Hubbert, Nils Meiswinkel, Ulrike Kutschan & Martin Kolditz

Authors
  1. Bernhard Schulte-Hubbert
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  2. Nils Meiswinkel
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  3. Ulrike Kutschan
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  4. Martin Kolditz
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Contributions

Conception, hypothesis, and design of the study: MK, NM, and BSH; acquisition of data: NM and UK; analysis and interpretation: BSH, MK, NM and UK; substantial involvement in the writing and revision of the article: BSH, MK, NM and UK; manuscript’s guarantor: MK.

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Correspondence to Martin Kolditz.

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The authors declare that there is no conflict of interest regarding the publication of this article.

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Schulte-Hubbert, B., Meiswinkel, N., Kutschan, U. et al. Prognostic value of blood pressure drops during the first 24 h after hospital admission for risk stratification of community-acquired pneumonia: a retrospective cohort study. Infection 48, 267–274 (2020). https://doi.org/10.1007/s15010-020-01391-x

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  • DOI: https://doi.org/10.1007/s15010-020-01391-x

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