scholarly journals Editorial Commentary:The Pneumonia Severity Index Score: Time to Move to a Prospective Study of Patients with Community‐Acquired Pneumonia who are Discharged from Emergency Departments to be Managed on an Ambulatory Basis

2007 ◽  
Vol 44 (1) ◽  
pp. 50-52 ◽  
Author(s):  
Thomas J. Marrie
Keyword(s):  
Prospective Study ◽  
Emergency Departments ◽  
Pneumonia Severity Index ◽  
Severity Index ◽  
Community Acquired Pneumonia ◽  
Index Score ◽  
Pneumonia Severity ◽  
Pneumonia Severity Index Score ◽  
Severity Index Score ◽  
A Prospective Study

scholarly journals Macrolide Use in the Treatment of Critically Ill Patients with Pneumonia: Incidence, Correlates, Timing and Outcomes

2013 ◽  
Vol 24 (4) ◽  
pp. e107-e112 ◽  
Author(s):  
Wendy I Sligl ◽  
Holly Hoang ◽  
Dean T Eurich ◽  
Atul Malhotra ◽  
Thomas J Marrie ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Pneumonia Severity Index ◽  
Severity Index ◽  
Index Score ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Pneumonia Severity ◽  
Pneumonia Severity Index Score ◽  
Severity Index Score

BACKGROUND: Macrolide antibiotics are commonly used to treat pneumonia despite increasing antimicrobial resistance. Evidence suggests that macrolides may also decrease mortality in severe sepsis via immunomodulatory properties.OBJECTIVE: To evaluate the incidence, correlates, timing and mortality associated with macrolide-based treatment.METHODS: A population-based cohort of critically ill adults with pneumonia at five intensive care units in Edmonton, Alberta, was prospectively followed over two years. Data collected included disease severity (Acute Physiology and Chronic Health Evaluation [APACHE] II score), pneumonia severity (Pneumonia Severity Index score), comorbidities, antibiotic treatments at presentation and time to effective antibiotic. The independent association between macrolide-based treatment and 30-day all-cause mortality was examined using multivariable Cox regression. A secondary exploratory analysis examined time to effective antimicrobial therapy.RESULTS: The cohort included 328 patients with a mean Pneumonia Severity Index score of 116 and a mean APACHE II score of 17; 84% required invasive mechanical ventilation. Ninety-one (28%) patients received macrolide-based treatments, with no significant correlates of treatment except nursing home residence (15% versus 30% for nonresidents [P=0.02]). Overall mortality was 54 of 328 (16%) at 30 days: 14 of 91 (15%) among patients treated with macrolides versus 40 of 237 (17%) for nonmacrolides (adjusted HR 0.93 [95% CI 0.50 to 1.74]; P=0.8). Patients who received effective antibiotics within 4 h of presentation were less likely to die than those whose treatment was delayed (14% versus 17%; adjusted HR 0.50 [95% CI 0.27 to 0.94]; P=0.03).CONCLUSIONS: Macrolide-based treatment was not associated with lower 30-day mortality among critically ill patients with pneumonia, although receipt of effective antibiotic within 4 h was strongly predictive of survival. Based on these results, timely effective treatment may be more important than choice of antibiotics.

How biomarkers can improve pneumonia diagnosis and prognosis: procalcitonin and mid-regional-pro-adrenomedullin

2020 ◽  
Vol 14 (7) ◽  
pp. 549-562
Author(s):  
Silvia Spoto ◽  
Jacopo M Legramante ◽  
Marilena Minieri ◽  
Marta Fogolari ◽  
Alessandro Terrinoni ◽  
...  
Keyword(s):  
Pneumonia Severity Index ◽  
Severity Index ◽  
Index Score ◽  
Prognostic Role ◽  
Characteristic Analysis ◽  
Pneumonia Severity ◽  
Diagnosis And Prognosis ◽  
Pneumonia Severity Index Score ◽  
Severity Index Score ◽  
Pneumonia Diagnosis

Aim: The diagnostic and prognostic role of procalcitonin (PCT) and mid-regional-pro-adrenomedullin (MR-proADM) were investigated in patients with pneumonia. Material & methods: A total of 168 and 77 patients with pneumonia enrolled in two different hospital settings, an internal medicine unit and an emergency unit were included in the study. PCT and MR-proADM plasma concentrations and pneumonia severity index score were measured. Median values were compared by Mann–Whitney’s test. Receiver operating characteristic analysis and rank correlation were used to define the diagnostic and prognostic accuracy. Results: PCT confirmed the diagnostic role at values 0.08–0.10 ng/ml and MR-proADM the prognostic role for severe pneumonia. Significant correlation (p < 0.0001) between MR-proADM and pneumonia severity index score indicated expression of pneumonia severity. Conclusion: This combination of biomarkers presents a high positive predictive value in pneumonia diagnosis and prognosis.

A Prospective Study of Presepsin as an Indicator of the Severity of Community-Acquired Pneumonia in Emergency Departments: Comparison with Pneumonia Severity Index and CURB-65 Scores

2019 ◽  
Vol 50 (4) ◽  
pp. 364-369 ◽  
Author(s):  
Ji Yeon Ham ◽  
Kyung Eun Song
Keyword(s):  
Prospective Study ◽  
Point Of Care ◽  
Pneumonia Severity Index ◽  
Biological Marker ◽  
Severity Index ◽  
Community Acquired Pneumonia ◽  
Pneumonia Severity ◽  
Point Of Care Test ◽  
Risk Patients ◽  
A Prospective Study

Abstract Despite widely used severity indices such as the pneumonia severity index (PSI) and CURB-65, a rapid, easy-to-detect biological marker is required for assessment of community-acquired pneumonia (CAP) severity. We aimed to investigate the ability of presepsin to differentiate between high- and low-risk patients, categorized according to PSI and CURB-65 scores. This prospective study was performed in an emergency department (ED) with 90 CAP patients. Whole blood presepsin levels were measured with a point-of-care test instrument. Using PSI and CURB-65 scores, we classified patients into outpatient (low-score group of PSI and CURB-65) and inpatient (high-score group of PSI and CURB-65) management groups. Presepsin levels were significantly higher in CAP patients with the high-score groups compared to the corresponding low-score groups. Presepsin correlated well with low- and high-score PSI (ROC AUC: presepsin, 0.726; PCT, 0.614; CRP, 0.544) and CURB-65 groups (ROC AUC: presepsin, 0.669; PCT, 0.645; CRP, 0.602). Presepsin is a valuable biomarker for assessing and classifying CAP severity.

scholarly journals Characterizing and Developing Strategies for the Treatment of Community-Acquired Pneumonia at a Community Hospital

2002 ◽  
Vol 9 (4) ◽  
pp. 247-252 ◽  
Author(s):  
Mark C Fok ◽  
Zahra Kanji ◽  
Rajesh Mainra ◽  
Michael Boldt
Keyword(s):  
Peer Group ◽  
Pneumonia Severity Index ◽  
Retrospective Chart Review ◽  
Severity Index ◽  
Early Discharge ◽  
Primary Diagnosis ◽  
Community Acquired Pneumonia ◽  
Pneumonia Severity ◽  
Pneumonia Severity Index Score ◽  
Step Down

BACKGROUND: Patients admitted to Lions Gate Hospital, North Vancouver, British Columbia, with a primary diagnosis of community-acquired pneumonia (CAP) have a mean length of stay (LOS) of 9.1 days compared with 7.9 days for peer group hospitals. This difference of 1.2 days results in an annual potential savings of 406 bed days and warranted an investigation into the management of CAP.OBJECTIVE: To characterize and provide recommendations for the management of CAP.METHODS: A retrospective chart review of patients admitted with a primary diagnosis of CAP between May 1, 2000 and August 31, 2000.RESULTS: Fifty-one patients were included in the study, with a mean LOS of 9.9 days and a median LOS of five days. Based on pneumonia severity index scores calculated for each patient, eight patients (16%) were admitted inappropriately. Initial empirical antibiotic choices were consistent with the Canadian CAP guidelines in 27 patients (53%), with inconsistencies arising mainly because cephalosporin or azithromycin monotherapy regimens were prescribed. Step-down from intravenous to oral antibiotics occurred in approximately 20 patients (39%). An additional 12 patients (24%) could have undergone step-down, and step-down was not applicable in 19 patients (37%). The potential annual cost avoidance from implementing admission criteria based on a pneumonia severity index score, applying step-down criteria and promoting early discharge criteria was estimated to be $220,000.CONCLUSIONS: Considerable variability exists in the treatment of CAP. A CAP preprinted order sheet was developed to address the issues identified in the present study and provide consistency in the management of CAP at Lions Gate Hospital.

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