Abstract
IntroductionHealthcare-associated pneumonia (HCAP) is a relatively new category of pneumonia. It refers to infections that occur prior to hospital admission in patients with specific risk factors following contact or exposure to a healthcare environment. There is currently no scoring index to predict the outcomes of HCAP patients. We applied and compared different community acquired pneumonia (CAP) scoring indices to predict 30-day mortality and 3-day and 14-day intensive care unit (ICU) admission in patients with HCAP.MethodsWe conducted a retrospective cohort study based on an inpatient database from six medical centers, recruiting a total of 444 patients with HCAP between 1 January 2007 and 31 December 2007. Pneumonia severity scoring indices including PSI (pneumonia severity index), CURB 65 (confusion, urea, respiratory rate, blood pressure, age 65), IDSA/ATS (Infectious Diseases Society of America/American Thoracic Society), modified ATS rule, SCAP (severe community acquired pneumonia), SMART-COP (systolic blood pressure, multilobar involvement, albumin, respiratory rate, tachycardia, confusion, oxygenation, pH), SMRT-CO (systolic blood pressure, multilobar involvement, respiratory rate, tachycardia, confusion, oxygenation), and SOAR (systolic blood pressure, oxygenation, age, respiratory rate) were calculated for each patient. Patient characteristics, co-morbidities, pneumonia pathogen culture results, length of hospital stay (LOS), and length of ICU stay were also recorded.ResultsPSI (>90) has the highest sensitivity in predicting mortality, followed by CURB-65 (≥2) and SCAP (>9) (SCAP score (area under the curve (AUC): 0.71), PSI (AUC: 0.70) and CURB-65 (AUC: 0.66)). Compared to PSI, modified ATS, IDSA/ATS, SCAP, and SMART-COP were easy to calculate. For predicting ICU admission (Day 3 and Day 14), modified ATS (AUC: 0.84, 0.82), SMART-COP (AUC: 0.84, 0.82), SCAP (AUC: 0.82, 0.80) and IDSA/ATS (AUC: 0.80, 0.79) performed better (statistically significant difference) than PSI, CURB-65, SOAR and SMRT-CO.ConclusionsThe utility of the scoring indices for risk assessment in patients with healthcare-associated pneumonia shows that the scoring indices originally designed for CAP can be applied to HCAP.
Highlights
Healthcare-associated pneumonia (HCAP) is a relatively new category of pneumonia
The utility of the scoring indices for risk assessment in patients with healthcare-associated pneumonia shows that the scoring indices originally designed for community acquired pneumonia (CAP) can be applied to HCAP
The need for intensive care unit (ICU) care was better identified with the systolic blood pressure (SOAR) model compared to the other scoring rules (CURB, CURB-65, CRB-65) in patients with nursing home acquired pneumonia [12], a subgroup of HCAP
Summary
It refers to infections that occur prior to hospital admission in patients with specific risk factors following contact or exposure to a healthcare environment. We applied and compared different community acquired pneumonia (CAP) scoring indices to predict 30-day mortality and 3-day and 14-day intensive care unit (ICU) admission in patients with HCAP. Healthcare-associated pneumonia (HCAP), a relatively new category of pneumonia, refers to infections that occur prior to hospital admission in patients with contact or exposure to a healthcare environment [1]. In the current era of rising healthcare costs, the decision to hospitalize adults with CAP has received considerable attention and many pneumonia severity prediction rules have been designed to stratify patients with CAP into risk groups [7,8]. The need for ICU care was better identified with the SOAR (systolic blood pressure, oxygenation, age, respiratory rate) model compared to the other scoring rules (CURB (confusion, urea, respiratory rate, blood pressure), CURB-65 (confusion, urea, respiratory rate, blood pressure, age 65), CRB-65 (confusion, respiratory rate, blood pressure, age 65)) in patients with nursing home acquired pneumonia [12], a subgroup of HCAP
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