Highlights
- •First evaluation of CRB-65 and qSOFA in pneumonia with immunosuppression.
- •qSOFA and CRB-65 show moderate prediction of death or organ failure.
- •Even with scores of 0, negative predictive values were below 90%.
- •With scores >1, positive predictive values were 36% (CRB-65) and 58% (qSOFA).
Abstract
Background
Scores for risk prediction used in immunocompetent patients with sepsis or pneumonia
are poorly evaluated in immunocompromised patients. Therefore, we evaluated the prognostic
value of the qSOFA- and CRB-65-criteria in immunocompromised patients presenting with
pneumonia.
Methods
Retrospective cohort study including consecutive patients hospitalized with pneumonia
and immunosuppression without treatment restrictions. The qSOFA and CRB-65 criteria
were documented in the emergency department. Outcome was defined as need of mechanical
ventilation (MV) or vasopressor support (VS) and/or hospital-mortality.
Results
41 of 198 (21%) patients reached the outcome and 10% died. Both, the CRB-65 and qSOFA-
were independently associated with the outcome (all p<0.01), but age was not predictive.
ROC curve analysis showed moderate predictive potential for both scores (CRB-65: AUC
0.63 and qSOFA: 0.69). With scores of 0, the negative predictive values were below
90% (CRB-65: 9/60 and qSOFA: 12/105 missed patients). With scores > 1, the positive
predictive values were 36% (CRB-65) and 58% (qSOFA), respectively.
Conclusions
Both, the qSOFA and the CRB-65 only showed moderate prognostic value, and negative
predictive values were inadequate to exclude organ failure or death in patients with
immunosuppression. In this population, age was not a predictive parameter. Patients
with > 1 positive vital sign criterion measured by both scores should be assessed
for organ failure.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of Internal MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Clinical and economic burden of community-acquired pneumonia among adults in Europe.Thorax. 2012; 67: 71-79
- Meta-analysis of calibration, discrimination, and stratum-specific likelihood ratios for the CRB-65 score.J Gen Intern Med. 2019; 34: 1304-1313
- Role of qSOFA in predicting mortality of pneumonia: a systematic review and meta-analysis.Medicine (Baltimore). 2018; 97 (e12634)
- Comparison of the qSOFA and CRB-65 for risk prediction in patients with community-acquired pneumonia.Intensive Care Med. 2016; 42: 2108-2110
- New Sepsis definition (sepsis-3) and community-acquired pneumonia mortality. a validation and clinical decision-making study.Am J Respir Crit Care Med. 2017; 196: 1287-1297
- Burden and risk factors of ambulatory or hospitalized CAP: a population based cohort study.Respir Med. 2016; 121: 32-38
- Pneumonia severity index in the immunocompromised.Can Respir J. 2006; 13: 89-93
- Prevalence and etiology of community-acquired pneumonia in immunocompromised patients.Clin Infect Dis. 2019; 68: 1482-1493
- Validation of a method to identify immunocompromised patients with severe sepsis in administrative databases.Ann Am Thorac Soc. 2016; 13: 253-258
- Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American thoracic society and infectious diseases society of America.Am J Respir Crit Care Med. 2019; 200: e45-e67
- Guidelines for the management of adult lower respiratory tract infections–full version.Clin Microbiol Infect. 2011; 17: E1-59
- Delayed intensive care unit admission is associated with increased mortality in patients with cancer with acute respiratory failure.Leuk Lymphoma. 2013; 54: 1724-1729
- Effect of early intervention on long-term outcomes of critically Ill cancer patients admitted to ICUs.Crit Care Med. 2015; 43: 1439-1448
- Severity assessment of healthcare-associated pneumonia and pneumonia in immunosuppression.Eur Respir J. 2012; 40: 1201-1210
- The pneumonia severity index and the CRB-65 in cancer patients with community-acquired pneumonia.Int J Tuberc Lung Dis. 2009; 13: 1550-1556
- Community-, healthcare-, and hospital-acquired severe sepsis hospitalizations in the university healthsystem consortium.Crit Care Med. 2015; 43: 1945-1951
- Predictive performance of the quick Sequential Organ Failure Assessment score as a screening tool for sepsis, mortality, and intensive care unit admission in patients with febrile neutropenia.Support Care Cancer. 2017; 25: 1557-1562
- New perspectives on community-acquired pneumonia in 388 406 patients. Results from a nationwide mandatory performance measurement programme in healthcare quality.Thorax. 2009; 64: 1062-1069
- A method of comparing the areas under receiver operating characteristic curves derived from the same cases.Radiology. 1983; 148: 839-843
- Validation of the Infectious Diseases Society of America/American Thoratic Society minor criteria for intensive care unit admission in community-acquired pneumonia patients without major criteria or contraindications to intensive care unit care.Clin Infect Dis. 2011; 53: 503-511
- IDSA/ATS minor criteria aid pre-intensive care unit resuscitation in severe community-acquired pneumonia.Eur Respir J. 2014; 43: 852-862
- The burden of pneumococcal pneumonia - experience of the German competence network CAPNETZ.Pneumologie. 2012; 66: 470-475
- Utility of bronchoalveolar lavage in the management of immunocompromised patients presenting with lung infiltrates.BMC Pulm Med. 2019; 19: 51
- Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study.Thorax. 2003; 58: 377-382
- Community-acquired pneumonia as medical emergency: predictors of early deterioration.Thorax. 2015; 70: 551-558
- Assessment of oxygenation and comorbidities improves outcome prediction in patients with community-acquired pneumonia with a low CRB-65 score.J Intern Med. 2015; 278: 193-202
- Admission lactate predicts poor prognosis independently of the CRB/CURB-65 scores in community-acquired pneumonia.Clin Microbiol Infect. 2017;
- Prediction model for mortality in cancer patients with pneumonia: comparison with CURB-65 and PSI.Clin Respir J. 2018; 12: 538-546
- Serum lactate is associated with mortality in severe sepsis independent of organ failure and shock.Crit Care Med. 2009; 37: 1670-1677
- Developing a new definition and assessing new clinical criteria for septic shock: for the third international consensus definitions for sepsis and septic shock (sepsis-3).JAMA. 2016; 315: 775-787
Article info
Publication history
Published online: August 07, 2020
Accepted:
August 1,
2020
Received in revised form:
July 3,
2020
Received:
April 7,
2020
Identification
Copyright
© 2020 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
