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Wang X, Jiao J, Wei R, Feng Y, Ma X, Li Y, Du Y. A new method to predict hospital mortality in severe community acquired pneumonia. Eur J Intern Med 2017; 40:56-63. [PMID: 28320569 DOI: 10.1016/j.ejim.2017.02.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 02/16/2017] [Accepted: 02/18/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND & AIMS The aim of this study is to develop a new method that is able to accurately predict the 28day hospital mortality in patients with severe community acquired pneumonia (SCAP) at an early stage. METHODS We selected 37,348 SCAP patients in ICU from 173 hospitals during 2011.1-2013.12. The predictive factors for 28day hospital mortality were evaluated retrospectively. All cases underwent intensive care, blood routine, blood biochemical tests and arterial blood gas analysis. Under the Classification and Regression Tree (CART) analysis, a new clinical scoring system was developed for early prediction in SCAP patients. The receiver-operating characteristic (ROC) curve was plotted to calculate the area under the receiver operating characteristic curve (AUC). RESULTS A novel clinical model named CLCGH scoring system, including Serum creatinine (Cr) >259.5μmol/L, leukocyte (WBC)>17.35×109/L, C-reactive protein (CRP)>189.4μg/mL, GCS≤9 and serum HCO3-≤17.65mmol/L, was carried out and each index was an independent factor for hospital mortality in SCAP. In validation cohort, the AUC of the new scoring system was 0.889 for prediction of hospital mortality, which was similar to SOFA score 0.877, APACHEII score 0.864, and was better than the PSI score 0.761 and CURB-65 score 0.767. CONCLUSIONS The new scoring system CLCGH is an efficient, accurate and objective method to predicate the early hospital mortality among SCAP patients.
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Affiliation(s)
- Xin Wang
- Key Laboratory of Hormones and Development (Ministry of Health), Tianjin Key Laboratory of Metabolic Diseases, China; Tianjin Metabolic Diseases Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China; Department of General Surgery, The Fourth Center Hospital, Tianjin, China; Center for Pulmonary Disease, Division of ICU, The Fourth Center Hospital, Tianjin, China
| | - Jianlong Jiao
- Department of General Surgery, The Fourth Center Hospital, Tianjin, China
| | - Rongwei Wei
- Department of General Surgery, The Fourth Center Hospital, Tianjin, China
| | - Yongli Feng
- Department of General Surgery, The Fourth Center Hospital, Tianjin, China
| | - Xiuqin Ma
- Department of General Surgery, The Fourth Center Hospital, Tianjin, China
| | - Yuan Li
- Department of General Surgery, The Fourth Center Hospital, Tianjin, China
| | - Yue Du
- Department of Public Health, Tianjin Medical University, Tianjin, China; Center of Evidence-based Medicine, Department of statistics and epidemiology, College of Public Health, Tianjin Medical University, China.
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Claverias L, Marí M, Marín-Corral J, Magret M, Trefler S, Bodí M, García-España A, Yébenes JC, Pascual S, Gea J, Rodríguez A. The prognostic value of muscle regional oxygen saturation index in severe community-acquired pneumonia: a prospective observational study. J Intensive Care 2016; 4:7. [PMID: 26788325 PMCID: PMC4717666 DOI: 10.1186/s40560-016-0129-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 01/13/2016] [Indexed: 01/08/2023] Open
Abstract
Background Community-acquired pneumonia (CAP) mortality exceeds 20 % in critical care patients despite appropriate antibiotic therapy. Regional tissue oxygen saturation index (rSO2) measured with near-infrared spectroscopy (NIRS) might facilitate early detection for patients at risk of serious complications. Our objectives were to determine the relationship between early determination of rSO2 and mortality and to compare discrimination power for mortality of rSO2 and other resuscitation variables in critically ill CAP patients. Methods This is a prospective observational study. Patients with CAP were enrolled within 6 h to intensive care admission. Demographics and clinical variables were recorded. rSO2 was determined using NIRS in brachioradialis muscle. All variables were determined at baseline and 24 h after admission. Results Forty patients were enrolled. Fourteen patients (35 %) had a baseline rSO2 < 60 % and 7 of them died (50 %). Only 1 of 26 (3.8 %) patients with rSO2 ≥ 60 % died (p = 0.007). The area under ROC curve (AUROC) showed consistent mortality discrimination at baseline (0.84, p = 0.03) and at 24 h (0.86, p = 0.006) for rSO2 values. Cox regression analysis showed that “low” rSO2 at ICU admission (hazard ratio (HR) = 8.99; 95 % confidence interval (CI) 1.05–76.8; p = 0.045) and “low” rSO2 at 24 h (HR = 13.18; 95 % CI 1.52–113.6; p = 0.019) were variables independently associated with mortality. In contrast, other variables such as Acute Physiology and Chronic Health Evaluation (APACHE II) score (HR = 1.09; 95 % CI 0.99–1.19; p = 0.052) were not associated with mortality. Conclusions Our findings suggest that forearm skeletal muscle rSO2 differs in patients with severe CAP according to outcome and might be an early prognosis tool.
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Affiliation(s)
- Laura Claverias
- Joan XXIII University Hospital, Critical Care Department, IISPV/URV, Carrer Dr. Mallafre Guasch 4, 43007, Tarragona, Spain ; Research Unit, Joan XXIII University Hospital, IISPV/URV, Tarragona, Spain
| | - Michael Marí
- Joan XXIII University Hospital, Critical Care Department, IISPV/URV, Carrer Dr. Mallafre Guasch 4, 43007, Tarragona, Spain
| | - Judith Marín-Corral
- Joan XXIII University Hospital, Critical Care Department, IISPV/URV, Carrer Dr. Mallafre Guasch 4, 43007, Tarragona, Spain
| | - Mónica Magret
- Joan XXIII University Hospital, Critical Care Department, IISPV/URV, Carrer Dr. Mallafre Guasch 4, 43007, Tarragona, Spain
| | - Sandra Trefler
- Joan XXIII University Hospital, Critical Care Department, IISPV/URV, Carrer Dr. Mallafre Guasch 4, 43007, Tarragona, Spain ; Research Unit, Joan XXIII University Hospital, IISPV/URV, Tarragona, Spain
| | - María Bodí
- Joan XXIII University Hospital, Critical Care Department, IISPV/URV, Carrer Dr. Mallafre Guasch 4, 43007, Tarragona, Spain ; Research Unit, Joan XXIII University Hospital, IISPV/URV, Tarragona, Spain
| | | | | | - Sergi Pascual
- CIBER de enfermedades respiratorias (CIBERES), ISC III, Bunyola Palma de Mallorca, Spain ; Parc de Salut Mar, IMIM, Pneumology Department, CEXS, UPF, Barcelona, Spain
| | - Joaquim Gea
- CIBER de enfermedades respiratorias (CIBERES), ISC III, Bunyola Palma de Mallorca, Spain ; Parc de Salut Mar, IMIM, Pneumology Department, CEXS, UPF, Barcelona, Spain
| | - Alejandro Rodríguez
- Joan XXIII University Hospital, Critical Care Department, IISPV/URV, Carrer Dr. Mallafre Guasch 4, 43007, Tarragona, Spain ; Research Unit, Joan XXIII University Hospital, IISPV/URV, Tarragona, Spain
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