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. (27th January 2015)

• Record Type: Journal Article
• Authors: Alan, M.; Grolimund, E.; Kutz, A.; Christ‐Crain, M.; Thomann, R.; Falconnier, C.; Hoess, C.; Henzen, C.; Zimmerli, W.; Mueller, B.; Schuetz, P.; the ProHOSP study group
• Is Part Of: Journal of internal medicine. Volume 278:Number 2(2015:Aug.)
• Page Start: 174
• Page End: 184
• Publication Date: 2015-01-27
• Subjects: Internal medicine -- Periodicals; Medicine -- Periodicals; 616
• DOI: 10.1111/joim.12341
• Languages: English
• ISSNs: 0954-6820

Abstract

<abstract abstract-type="main" id="joim12341-abs-0001"> <title>Abstract</title> <sec id="joim12341-sec-0001" sec-type="section"> <title>Objective</title> <p>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.</p> </sec> <sec id="joim12341-sec-0002" sec-type="section"> <title>Design, setting and subjects</title> <p>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.</p> </sec> <sec id="joim12341-sec-0003" sec-type="section"> <title>Main outcome measure</title> <p>All‐cause mortality during a 6‐year follow‐up period.</p> </sec> <sec id="joim12341-sec-0004" sec-type="section"> <title>Results</title> <p>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; <italic>P</italic> < 0.0001) and the CURB‐65 score (AUC increase from 0.73 to 0.80; <italic>P</italic> < 0.001).</p> </sec> <sec id="joim12341-sec-0005" sec-type="section"> <title>Conclusion</title> <p>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.</p> </sec> </abstract>