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  • Poster presentation
  • Open Access

Prognostic assessment in community-acquired pneumonia by pneumonia severity scores and biomarkers

  • 1,
  • 1,
  • 2 and
  • 1
Critical Care201014 (Suppl 1) :P75

https://doi.org/10.1186/cc8307

  • Published:

Keywords

  • Pneumonia
  • Severity Score
  • Healthcare Resource
  • Procalcitonin
  • Characteristic Curf

Introduction

Classical biomarkers like C-reactive protein (CRP) or the leucocyte count are only inaccurate tools for predicting the severity of community-acquired pneumonia (CAP). Procalcitonin (PCT) was found to predict 28-day mortality in CAP (area under the curve (AUC) 0.8) similar to the combination of PCT and CRB65 score (AUC 0.83) [1]. Novel prognostic biomarkers, such as Pro-ET1 and MR-ProADM, were shown to correlate with CAP severity [2]. We aimed to compare the diagnostic accuracy to predict mortality and ICU admission of clinical severity scores, biomarkers and their combination.

Methods

Nine hundred and twenty-five CAP patients enrolled in the ProHOSP trial [3] were analyzed by assessing clinical severity scores (SMART-COP, PSI, CURB65) and biomarker levels (PCT, MR-ProADM, Pro-ET1). Receiver operating characteristic curves for 30-day mortality and ICU admission were used to calculate and compare the different predictive values.

Results

The AUC for the prediction of 30-day mortality was 0.84 with SMART-COP, 0.82 with PSI, 0.72 with CURB65, 0.59 with PCT, 0.75 with MR-ProADM and 0.75 with ProET1. ICU admission was predicted best by SMART-COP (AUC 0.83), compared with the other severity scores and biomarkers (PSI: 0.68, CURB65: 0.65, PCT: 0.7, Pro-ET1: 0.73, ProADM: 0.72). The combination of SMART-COP and MR-ProADM was superior to SMART-COP alone (AUC 0.84, P = 0.04).

Conclusions

The combination of MR-ProADM with SMART-COP significantly improved the prediction of ICU admission. Prognostic biomarkers should complement the clinical assessment of patients with LRTI to improve allocation of healthcare resources to high-risk patients.

Authors’ Affiliations

(1)
Kantonsspital Aarau, Switzerland
(2)
University Hospital Basel, Switzerland

References

  1. Krüger S, et al: Eur Respir J. 2008, 31: 349-355. 10.1183/09031936.00054507.View ArticleGoogle Scholar
  2. Schuetz P, et al: BMC Inf Dis. 2008, 8: 22-30. 10.1186/1471-2334-8-22.View ArticleGoogle Scholar
  3. Schuetz P, et al: JAMA. 2009, 302: 1059-1066. 10.1001/jama.2009.1297.View ArticleGoogle Scholar

Copyright

© BioMed Central Ltd. 2010

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