Year in review 2009: Critical Care- infection

Harbarth, Stephan; Haustein, Thomas

doi:10.1186/cc9268

Critical Care

Table 1 Comparison of community-acquired pneumonia risk scores for the prediction of intensive care unit treatment

From: Year in review 2009: Critical Care- infection

	REA-ICU index^a	SMART-COP^b	IDSA/ATS prediction rule^c	SCAP^d
Outcome	ICU transfer within 3 days of hospital admission	Need for intensive respiratory or vasopressor support	ICU admission	Mechanical ventilation, septic shock, or in-hospital death
Study inclusion criteria	Adult patients with CAP without respiratory failure or shock at the time of hospitalisation	Adult patients hospitalized with CAP	Patients aged > 15 years hospitalised for > 12 hours with CAP	Adult patients with CAP visiting the emergency department (including patients with expected terminal event)
Study exclusion criteria	Nursing home residents	Hospitalisation within the preceding 14 days, immunosuppression, receipt of parenteral antibiotics prior to obtainment of blood samples for culture, aspiration pneumonitis, withdrawal of active treatment within 12 hours because of a poor prognosis, pregnancy	Immunosuppression	Immunosuppression
Number of criteria	11	8	11 (2 major, 9 minor)	8 (2 major, 6 minor)
Variable underlying the criteria
Respiratory rate	•	•	•	•
Heart rate	•	•
Systolic blood pressure		•	•	•^e
Septic shock with need for vasopressors			•^e
Body temperature			•
Confusion/altered mental status		•	•	•
Invasive mechanical ventilation			•^e
Multilobar infiltrate	•	•	•	•
Oxygenation	•	•	•	•
Arterial pH	•	•		•^e
Blood urea nitrogen	•		•	•
Albumin level		•
Sodium	•
White blood cell count	•		•
Platelet count			•
Age	•			•
Gender	•
Co-morbid conditions	•
Sensitivity	14% (10 to 19)^g	92% (85 to 97)^g	71% (66 to 76)^f	92%^g
Specificity	97% (96 to 97)^g	62% (59 to 66)^g	88% (87 to 88)^f	74%^g
Area under ROC curve in derivation cohort	0.81 (0.78 to 0.83)^g	0.87 (0.83 to 0.91)^g	Not reported	0.83^g

CAP, community-acquired pneumonia; ICU, intensive care unit; ROC, receiver operating characteristic. ^aRenaud and colleagues [PMID 19358736] [46]. ^bCharles and colleagues [PMID 18558884] [44]. ^cLiapikou and colleagues [PMID 19140759] [45]. ^dEspaña and colleagues [PMID 16973986] [43]. ^eMajor criterion. ^fValues apply to validation cohort. ^gValues apply to derivation cohort.

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