Gökhan PERİNÇEK, Sema AVCI

The predictors of 3-month mortality in community-acquired pneumonia

Aim: The aim of the study was to compare the pneumonia severity scoring systems (PSI, CURB-65) and inflammatory markers (CRP, CAR, NLR and PLR) in predicting community-acquired pneumonia (CAP) patients’ 3-month mortality.Materials and Methods: This study included 113 patients (43 females, 70 males) diagnosed with CAP. Demographics, comorbidities, complete blood count, arterial blood gas, electrolytes, liver-renal functions and radiological findings were evaluated. PSI and CURB-65 were classified: PSI low risk (I-III, point ≤90); PSI moderate-high risk (IV-V, point 91≤); CURB-65; low risk (0-2) and high risk (3-5). All statistical calculations were performed with SPSS 23.0 for Windows.Results: The mean age of the patients was 69.08 ± 16.58 and 3-month mortality rate among the patients hospitalized on admission was 22.4% (n=24). Albumin, hemoglobin, lymphocyte, PaO2 were lower; NLR and lactate were higher in non-survivors. Albumin and lactate were higher in CURB-65 (0-2) and (3-5) groups, respectively. NLR was significantly higher in PSI group (IV-V). Red cell distribution width and lactate were lower in PSI (I-III); basophil and PaO2 were significantly lower in PSI group (IV-V). CRP (AUC 0.744), PSI classification (AUC 0.72) and PSI scoring (AUC 0.746) showed higher mortality prediction. Conclusion: Albumin, hemoglobin, lymphocyte, PaO2 were lower; NLR and lactate were higher in non-survivors. CRP and PSI score are potent predictors of 3-month mortality.

PDF

___

1. Shah BA, Ahmed W, Dhobi GN, et al. Validity of Pneumonia Severity Index and CURB-65 severity scoring systems in community acquired pneumonia in an Indian setting. Indian J Chest Dis Allied Sci 2010;52:9-17.
2. Julián-Jiménez A, Palomo de los Reyes MJ, Miguez RP, et al. Improved management of communityacquired pneumonia in the emergency department. Arch Bronconeumol 2013;49:230-40.
3. Holter JC, Ueland T, Jenum PA, et al. Risk factors for long-term mortality after hospitalization for community-acquired pneumonia: a 5-year prospective follow-up study. PLoS One 2016;11: e0148741.
4. Koskela HO, Salonen PH, Romppanen J, et al. Longterm mortality after community acquired pneumonia— impacts of diabetes and newly discovered hyperglycaemia: a prospective, observational cohort study. BMJ Open 2014;4: e005715.
5. Bulbul Y. Community-acquired pneumonia data in Turkey. Güncel Göğüs Hastalık Seri 2014;2:1-10.
6. Bruns AHW, Ooesterheert JJ, Cucciolillo MC, et al. Cause-specific long-term mortality rates in patients recovered from community-acquired pneumonia as compared with the general Dutch population. Clin Microbiol Infect 2011;17:763–8.
7. Viasus D, Cilloniz C, Cardozo CG, et al. Early, short and long-term mortality in community-acquired pneumonia. Ann Res Hosp 2018;2:5.
8. de Jager CP, Wever PC, Gemen EF, et al. The neutrophillymphocyte count ratio in patients with communityacquired pneumonia. PLoS ONE 2012;7: e46561.
9. Lee JH, Song S, Yoon SY, et al. Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio as diagnostic markers for pneumonia severity. Br J Biomed Sci 2016;73:140-2.
10. Ranzani OT, Prina E, Menendez R, et al. New sepsis definition (Sepsis-3) and community-acquired pneumonia mortality. A validation and clinical decision-making study. Am J Respir Crit Care Med 2015;196:1287-97.
11. Shehata SM, Sileem AE, Shahien NE. Prognostic values of pneumonia severity index, CURB-65 and expanded CURB-65 scores in community-acquired pneumonia in Zagazig University Hospitals. Egypt J Chest Dis Tuberc 2017;66:549-55.
12. Ebrahimzadeh A, Mohammadifard M, Naseh G, et al. Clinical and laboratory findings in patients with acute respiratory symptoms that suggest the necessity of chest x-ray for community-acquired pneumonia. Iran J Radiol 2015;12:e13547.
13. Zhang ZX, Yong Y, Tan WC, et al. Prognostic factors for mortality due to pneumonia among adults from different age groups in Singapore and mortality predictions based on PSI and CURB-65. Singapore Med J 2018;59:190-8.
14. Irfan M, Hussain SF, Mapara K, et al. Community acquired pneumonia: risk factors associated with mortality in a tertiary care hospitalized patients. J Pak Med Assoc 2009;59:448-52.
15. Madhu S, Augustine S, Kumar R, et al. Comparative study of CURB-65, Pneumonia Severity Index and IDSA/ATS scoring systems in community acquired pneumonia in an Indian tertiary care setting. Int J Adv Med 2017;4:693-700.
16. Damayanti N, Abidin A, Keliat EN. The correlation between albumin levels with 30 days mortality in community acquired pneumonia patients. Earth Environ Sci 2018;125:e012141.
17. Alsancak Y, Sivri S, Baştuğ S, et al. Role of calcium– albumin ratio in severity of coronary artery disease assessed by angiographic SYNTAX score. Arch Clin Exp Med 2018;3:174-8.
18. Vincent JL, Dubois MJ, Navickis RJ, et al. Hypoalbuminemia in acute illness: is there a rationale for intervention? A meta-analysis of cohort studies and controlled trials. Ann Surg 2003;237:319-34.
19. Martins EC, da Fe Silveira L, Viegas K, et al. Neutrophillymphocyte ratio in the early diagnosis of sepsis in an intensive care unit: a case-control study. Rev Bras Ter Intensiva 2019;31:63-70.
20. de Jager CPC, Wever PC, Eugenie FA. The neutrophillymphocyte count ratio in patients with communityacquired pneumonia. PLOS ONE 2012;7:e46561.
21. Ose D, Berzins A, Grigorovica K, et al. Lactate as a predictor in severe pneumonia. Acta Chir Latv 2015;15:29-34.
22. Chen Y-X, Li C-S. Lactate on emergency department arrival as a predictor of mortality and site-of-care in pneumonia patients:a cohort study. Thorax 2015;70:404–10.
23. Kuti BP, Adegoke SA, Ebruke BE, et al. Determinants of oxygen therapy in childhood pneumonia in a resourceconstrained region. ISRN Pediatr 2013;2013:435976.
24. Jung SM, Kim YJ, Ryoo SM, et al. Relationship between low hemoglobin levels and mortality in patients with septic shock. Acute Crit Care 2019;34:141-7.
25. Acanfora D, Scicchitano P, Carone M, et al. Relative lymphocyte count as an indicator of 3-year mortality in elderly people with severe COPD. BMC Pulmonary Medicine 2018;18:116.
26. Bello S, Fandos S, Lasierra AB, et al. Red blood cell distribution width and long-term mortality after community-acquired pneumonia. A comparison with proadrenomedullin. Respir Med 2015; 109:1193-206.
27. Piliponsky AM, Shubin NJ, Lahiri AK, et al. Basophilderived tumor necrosis factor can enhance survival in a sepsis model in mice. Nat Immunol 2019;20:129-40.