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Limited prognostic accuracy of the CRB-65 and qSOFA in patients presenting with pneumonia and immunosuppression

  • Sophie Frantz
    Affiliations
    Division of Pulmonology, Medical Department I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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  • Bernhard Schulte-Hubbert
    Affiliations
    Division of Pulmonology, Medical Department I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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  • Michael Halank
    Affiliations
    Division of Pulmonology, Medical Department I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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  • Dirk Koschel
    Affiliations
    Division of Pulmonology, Medical Department I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany

    Department of Pulmonary Diseases, Fachkrankenhaus Coswig, Centre for Pulmonary Diseases and Thoracic Surgery, Coswig, Germany
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  • Martin Kolditz
    Correspondence
    Corresponding author at: Division of Pulmonology, Medical Department I, University Hospital Carl Gustav Carus, Fetscherstr. 74, 01307 Dresden, Germany
    Affiliations
    Division of Pulmonology, Medical Department I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Published:August 07, 2020DOI:https://doi.org/10.1016/j.ejim.2020.08.006

      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.
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