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J Intern Med. 2015 Aug;278(2):174-84. doi: 10.1111/joim.12341. Epub 2015 Jan 27.

Clinical risk scores and blood biomarkers as predictors of long-term outcome in patients with community-acquired pneumonia: a 6-year prospective follow-up study.

Author information

1
University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland.
2
Department of Internal Medicine, Division of Endocrinology, Diabetes and Clinical Nutrition, University Hospital Basel, Basel, Switzerland.
3
Department of Internal Medicine, Bürgerspital Solothurn, Solothurn, Switzerland.
4
Basel University Medical Clinic Liestal, Liestal, Switzerland.
5
Department of Internal Medicine, Kantonsspital Münsterlingen, Münsterlingen, Switzerland.
6
Department of Internal Medicine, Kantonsspital Lucerne, Lucerne, Switzerland.

Abstract

OBJECTIVE:

Prediction of long-term outcomes in patients with community-acquired pneumonia (CAP) is incompletely understood. We investigated the value of clinical risk scores [pneumonia severity index (PSI) and CURB-65] (Confusion, Urea, Respiratory rate, Blood Pressure, Age >65 years) and blood biomarkers of different physiopathological pathways in predicting long-term survival in a well-characterized cohort of patients with CAP enrolled in an antibiotic stewardship trial.

DESIGN, SETTING AND SUBJECTS:

Patients admitted with CAP to six medical centres in Switzerland were prospectively followed for 6 years. Cox regression models and area under the receiver operating characteristics curve (AUC) were used to investigate associations between initial risk assessment and all-cause mortality.

MAIN OUTCOME MEASURE:

All-cause mortality during a 6-year follow-up period.

RESULTS:

Six-year mortality in the present cohort (median age 73 years) was 45.1% [95% confidence interval (CI) 41.8-48.3%]. Initial PSI and CURB-65 scores both had excellent long-term prognostic accuracy, with a stepwise increase in mortality per risk class. The hazard ratios (95% CI) of the highest PSI and CURB-65 classes (reference: lowest class) were 38.0 (14.0-103.0) and 7.8 (2.2-14.5), respectively, after 6 years. The addition of inflammatory (pro-adrenomedullin) and cardiac (pro-atrial natriuretic peptide) blood biomarkers measured upon hospital admission further improved the prognostic capabilities of the PSI (AUC increase from 0.79 to 0.83; P < 0.0001) and the CURB-65 score (AUC increase from 0.73 to 0.80; P < 0.001).

CONCLUSION:

Risk assessment using clinical scores allowed accurate long-term prognostication, which was further improved by the addition of two inflammatory (pro-adrenomedullin) and cardiac (pro-atrial natriuretic peptide) blood biomarkers. These data provide a rationale for a more risk-adapted, 'personalized' strategy for long-term management of patients with CAP.

KEYWORDS:

community-acquired pneumonia; long-term; mortality; outcomes; prognosis

PMID:
25529395
DOI:
10.1111/joim.12341
[Indexed for MEDLINE]
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