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Forgot Password? Sign In Required. LDH is a cytoplasmatic enzyme expressed in nearly all types of cells of the body. It is released into blood when cell experiences injury or death caused by ischaemia, excess heat or cold, starvation, dehydration, injury, bacterial toxins, drugs and chemical poisonings 15 , 16 , LDH has been used as an indicator of cellular injury induced by various etiologies.
Previous studies have demonstrated that the elevated LDH in serum, especially in bronchoalveolar lavage BAL and pleural fluid can help determine the extent of lung tissue damage and inflammation such as pulmonary embolism , P. The higher serum LDH level indicates the more severe complications and the worse prognosis. Thrombocytopenia and hypoalbuminemia also serve as markers indicating that patients need ICU admission and may result in a higher mortality in hospitalized CAP patients 25 , 26 , 27 , Hypoalbuminemia, which can be caused by malnutrition, liver cirrhosis, or infection process, contributes to an increased mortality in hospitalized patients 31 , and several studies have identified a close correlation between serum albumin concentration and mortality in CAP patients 6 , 7 , 28 , 32 , Recently, the studies suggested that either pre-existing diabetes or acute hyperglycemia without pre-existing diabetes was associated with longer LOS and higher mortality in CAP patients 34 , However, our data did not show a positive correlation between hyperglycemia and the day mortality.
PSI, which draws the score from 20 variables, is accurate in predicting the day mortality, but its complexity limits clinical application. Contrarily, CURB features simplicity. The SMART-COP, which is processed by logistic regression analysis, provides superior accuracy for prediction of the need for intensive respiratory or vosopressor support, but it is a still complicated process to calculate multiple points for different variables and age-adjusted cut-off.
Compared to CURB and other assessment tools, the expanded-CURB score, which extends independent risk factors to 8 variables in assessing CAP severity, significantly improves identifying high-risk patients, through decreasing the relative weight of age and blood pressure, and eliminating the use of imaging and comorbid illnesses in the calculation.
The only gap remains among HCAP patients, since data from validation cohort did not confirm a good performance of the score in this subgroup of patients. HCAP comprises a heterogeneous population of patients with more comorbidities, recent healthcare contacts and increased risk of multidrug resistance pathogens. The findings of our study confirm the need of further characterization of the subgroup of patients fulfilling HCAP definition, to improve the initial assessment and management of this category.
There are a few limitations in this study. First, this is a retrospective single center study and no outpatients were included. Second, although the blood samples were collected as soon as patients were admitted, there were variations in the timing of collecting. However, our data were validated on a prospective cohort of patients with pneumonia observed in a geographic area completely different in term of demographic features, predisposing factors, and hospital resources.
Thus we believe that it is the major strength of our study. In conclusion, our expanded CURB is a relatively simpler and more effective marker in assessing the severity of hospitalized patients with CAP.
Despite the encouraging results, further validation is warranted in future multicenter large prospective studies. How to cite this article : Liu, J. Expanded CURB a new score system predicts severity of community-acquired pneumonia with superior efficiency. The error has not been fixed in the paper. Scientific Reports 6: Article number: ; published online: 18 March ; updated: 09 August This Article contains typographical errors in Table 2 in the Multivariate logistic regression analysis section.
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Ann Intern Med. Falcone, M. Healthcare-associated pneumonia: diagnostic criteria and distinction from community-acquired pneumonia. Int J Infect Dis. Fine, M. A prediction rule to identify low risk patients with community-acquired pneumonia. N Engl J Med. Lim, W. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validationstudy.
Charles, P. Clin Infect Dis. Miyashita, N. Japanese Respiratory Society. The JRS guidelines for the management of community-acquired pneumonia in adults: an update and new recommendations.
Intern Med. Niederman, M. American Thoracic Society Guidelines for the management of adults with community-acquired pneumonia. Diagnosis, assessment of severity, antimicrobial therapy, and prevention. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia.
Mandell, L. Yuichiro, S. Individualizing risk of multidrug-resistant pathogens in community-onset pneumonia. PLoS One. Lower mortality rate in elderly patients with community-onset pneumonia on treatment with aspirin. J Am Heart Assoc 4 , e Glick, J. Correctly identifying severe community-acquired pneumonia cases will also reduce the inappropriate use of intravenous antibiotics, thereby reducing the risk of antibiotic-associated colitis, which is an important issue for health service utilisation, mortality, and morbidity [ 8 ].
The CURB severity index, recommended by the British Thoracic Society [ 9 ], compares similarly with other severity scores [ 10 ] and is a readily applied tool that can be used to guide site of care and degree of medical intervention.
Recent comprehensive reviews [ 10 , 11 ] have drawn attention to the limitations of current established community-acquired pneumonia severity assessment criteria. Patients with scores of 3 or more are classed as having severe pneumonia. While younger and older patients alike have been shown to mount similar immunoresponses to pneumonia infection [ 12 ], concerns over the use of age-dependent scoring systems have been raised given the variability of presentation between different age groups [ 13 ].
The potential for misleadingly low scores in patients younger than 65 years has been declared [ 14 , 15 ]. The inclusion of chronological age in severity assessments may also lead to false positive results amongst some older patients while, conversely, systolic hypertension with increasing age may lead to false negatives in older patients.
Diastolic blood pressure criteria may therefore not have the same implication for older patients as for younger patients, further complicating its use as part of CURB severity scoring. Cardiovascular shock in community-acquired pneumonia has previously been identified as an independent prognostic factor for mortality [ 18 ].
The exclusion of urea as a marker of severity negates the need for any biochemical testing, and the patient's score is calculated solely on clinical measurements which can be recorded by a general practitioner before deciding on whether to admit a patient to hospital or maintain care within the community. Such decisions have important implications for both the patient, the healthcare professionals looking after them, and the resources available to both. A recent meta-analysis of CRB [ 25 ] reports howerver that it overpredicts the probability of mortality in the community setting and should be used with caution.
Unselected adults admitted to a respiratory team in a large acute general hospital with community-acquired pneumonia were included in the study. CAP was defined as the presence of new shadowing on admission chest X-ray and clinical features consistent with pneumonia e. Only patients in whom CAP was the main reason for admission were included. Any patients in whom there was an expected terminal event or who developed hospital-acquired pneumonia were excluded from the study.
Patients were followed up in the respiratory medical clinic six weeks following admission. Data were collected prospectively over a month period April —June , as has been previously reported [ 3 ]. Hospital guidelines based on a previous British Thoracic Society study [ 21 ] were in use throughout this time period and used in guiding patient care. This adjustment was to account for the physiological increase in heart rate with rising temperature.
Five patients had one data variable missing from CURB, CURSI, and CURASI severity scoring, with one patient being excluded from the study due to a borderline score and allocation to the non-severe group which may have been switched to the severe group depending on the missing urea value. The addition of a positive confusion value may have resulted in an allocation to the severe group, and the patient was therefore excluded.
The sensitivities, specificities, and positive and negative predictive values were calculated for each of the criteria. SPSS The study data was collected as part of an internal audit cycle, and so local ethical committee approval was not required. No patient with missing data for parameters required for severity scoring was included in the analysis, unless their remaining recorded values confirmed their allocation to either the non-severe or severe group.
Patients were aged 17—96 years median age 61 years, mean age Eight patients died aged 55—80 years during the study. Ten patients were admitted to ICU, six of whom died. Three of the four ICU survivors were aged less than 65 years. Table 1 presents the cohort sample characteristics, including for age, gender, confusion, urea levels, respiratory rate, blood pressure, heart rate, and temperature. Article PubMed Google Scholar. Google Scholar.
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Dtsch Med Wochenschr. Crit Care Med. Intern Med. J Intern Med. Download references. We also thank the staff of the Office of Statistics and Elections, Herne, Germany, for their cooperation. You can also search for this author in PubMed Google Scholar. Correspondence to Ulrich Thiem. HN analysed and interpreted the data, performed the literature review and drafted the manuscript.
MP and TW contributed to the design of the study, collected the data and supported data analysis and interpretation. HJH and LP designed the study and interpreted the data. UT designed the study, contributed to the collection of data, performed analysis and interpretation of the data and assisted in preparing the first draft of the manuscript. All authors read and approved the final version of the manuscript. Reprints and Permissions. External validation of the CURSI criteria confusion, urea, respiratory rate and shock index in adults hospitalised for community-acquired pneumonia.
BMC Infect Dis 14, 39 Download citation. Received : 12 June Accepted : 20 January Published : 22 January Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article.
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