Severity of illness scoring systems in patients with bacteraemic pneumococcal pneumonia: implications for the intensive care unit care
| Autor: | C, Feldman, S, Alanee, V L, Yu, G A, Richards, A, Ortqvist, J, Rello, C C C, Chiou, M B F, Chedid, M M, Wagener, K P, Klugman, John D, Rihs |
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| Rok vydání: | 2009 |
| Předmět: |
Microbiology (medical)
medicine.medical_specialty community-acquired pneumonia Pneumonia severity index Bacteremia Sensitivity and Specificity Severity of Illness Index law.invention IDSA/ATS guidelines Community-acquired pneumonia Predictive Value of Tests law Internal medicine Intensive care Severity of illness Humans Medicine severity of illness Intensive care medicine Aged Aged 80 and over CURB-65 business.industry Bacterial pneumonia General Medicine Pneumonia Pneumococcal Prognosis medicine.disease Intensive care unit Intensive Care Units Streptococcus pneumoniae Infectious Diseases Pitt Bacteremia Score Pneumococcal pneumonia Bacteraemia Pneumonia Severity Index business |
| Zdroj: | Clinical Microbiology and Infection. 15:850-857 |
| ISSN: | 1198-743X |
| Popis: | Severity of illness scoring systems are useful for decisions on the management of patients with community-acquired pneumonia (CAP), including assessing the need for intensified therapy and monitoring, or for intensive care unit (ICU) admission. We compared the accuracy of the Pneumonia Severity Index (PSI), the CURB-65 and CRB-65 score, the modified-American Thoracic Society score (ATS), the IDSA/ATS guidelines and the Pitt Bacteraemia score (PBS) in evaluating severity of illness in 766 patients with bacteraemic pneumococcal pneumonia. We evaluated the sensitivity and specificity, the positive predictive value (PPV) and the negative predictive value (NPV) and the accuracy of the classification in predicting 14-day mortality. The PSI and the IDSA/ATS guidelines were the most sensitive whereas the PBS and modified-ATS scoring systems were the most specific in predicting mortality. The NPV was comparable for all four scoring systems (all above 90%), but the PPV was highest for PBS (54.2%) and lowest for PSI (23.2%). The predictive accuracy and discriminating power as measured by the receiver-operating characteristic (ROC) curve was highest for the PBS. Both the modified-ATS and the PBS scoring systems identified those patients who might benefit most from intensified care and monitoring. The PBS and modified-ATS proved superior to the IDSA/ATS guidelines, CURB-65 and CRB-65 with respect to their specificity and PPV. The low PPV of the PSI rendered it not usable as a parameter for decision-making in severely-ill patients with pneumococcal bacteraemia. |
| Databáze: | OpenAIRE |
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