| Severe community-acquired pneumonia: validation of the Infectious Diseases Society of America/American Thoracic Society guidelines to predict an intensive care unit admission. | |
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MedLine Citation:
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PMID: 19140759 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The recent Infectious Disease Society of America/American Thoracic Society guidelines for the management of community-acquired pneumonia (CAP) in adults defined a predictive rule to identify patients with severe CAP to determine the need for intensive care unit (ICU) admission. We clinically validated this rule. METHODS: We analyzed 2102 episodes of CAP in consecutively hospitalized patients over a 7-year period. The predictive rule consists of at least 1 of 2 major severity criteria (septic shock and invasive mechanical ventilation) or at least 3 of 9 minor severity criteria. We assessed the association of the predictive rule with ICU admission and mortality. RESULTS: A total of 235 episodes of CAP (11%) occurred in patients who were admitted to the ICU, whereas the predictive rule identified 397 (19%) of 2102 episodes as severe CAP. The predictive rule and the decision for ICU admission agreed in 1804 (86%) of the episodes (kappa coefficient, 0.45), with a sensitivity of 71% and a specificity of 88%, similar to the 2001 American Thoracic Society guidelines (sensitivity, 66%; specificity, 90%) in predicting ICU admission. Severe CAP criteria had higher sensitivity (58% vs. 46%) and similar specificity (88% vs. 90%), compared with the 2001 American Thoracic Society guidelines in predicting hospital mortality. Invasive mechanical ventilation was the main determinant for ICU admission, followed by septic shock. In the absence of major criteria, ICU admission was not related to survival of patients with minor severity criteria. CONCLUSIONS: The predictive rule to identify severe CAP is accurate for ICU admission and improved the prediction of mortality, compared with the previous American Thoracic Society guidelines. The need for ICU admission derived from minor severity criteria alone is uncertain and deserves further investigation. |
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Authors:
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Adamantia Liapikou; Miquel Ferrer; Eva Polverino; Valentina Balasso; Mariano Esperatti; Raquel Piñer; Jose Mensa; Nestor Luque; Santiago Ewig; Rosario Menendez; Michael S Niederman; Antoni Torres |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't; Validation Studies |
Journal Detail:
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Title: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America Volume: 48 ISSN: 1537-6591 ISO Abbreviation: Clin. Infect. Dis. Publication Date: 2009 Feb |
Date Detail:
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Created Date: 2009-07-09 Completed Date: 2009-08-31 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9203213 Medline TA: Clin Infect Dis Country: United States |
Other Details:
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Languages: eng Pagination: 377-85 Citation Subset: IM |
Affiliation:
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Servei de Pneumologia, Hospital Clinic, Instiut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Aged, 80 and over Community-Acquired Infections / diagnosis*, mortality Critical Illness* Female Guidelines as Topic* Hospitalization* Humans Male Middle Aged Pneumonia / diagnosis*, mortality Prognosis Severity of Illness Index United States |
| Comments/Corrections | |
Comment In:
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Clin Infect Dis. 2009 Feb 15;48(4):386-8
[PMID:
19140757
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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