Sequential organ failure assessment score is an excellent operationalization of disease severity of adult patients with hospitalized community acquired pneumonia - results from the prospective observational PROGRESS study

被引：39

作者：

Ahnert, Peter ^{[1
]}

Creutz, Petra ^{[2
,3
,4
,5
]}

Horn, Katrin ^{[1
]}

Schwarzenberger, Fabian ^{[6
]}

Kiehntopf, Michael ^{[7
,8
]}

Hossain, Hamid ^{[9
]}

Bauer, Michael ^{[10
]}

Brunkhorst, Frank Martin ^{[11
,12
]}

Reinhart, Konrad ^{[13
]}

Voelker, Uwe ^{[14
]}

Chakraborty, Trinad ^{[15
]}

Witzenrath, Martin ^{[16
,17
,18
]}

Loeffler, Markus ^{[16
,17
,18
]}

Suttorp, Norbert ^{[16
,17
,18
]}

Scholz, Markus ^{[1
]}

Angermair, Stefan ^{[19
]}

Christoph, Arntzen ^{[20
]}

Angermuende, Krankenhaus ^{[20
]}

Balke, Lorenz ^{[21
]}

Robert, Bals ^{[22
]}

Michael, Benzke ^{[23
]}

Ayhan, Berber ^{[24
]}

Frank, Bloos ^{[25
]}

Martin, Buchenroth ^{[26
]}

Lea, Deterding ^{[27
]}

Nicolas, Dickgreber ^{[28
]}

Oleg, Dmitriev ^{[29
]}

Hermann, Druckmiller ^{[29
]}

Holger, Flick ^{[30
]}

Ulrike, Foellmer ^{[31
]}

Julia, Freise ^{[32
]}

Carmen, Garcia ^{[33
]}

Sven, Glaeser ^{[34
]}

Christian, Grah ^{[92
]}

Simone, Hamberger ^{[35
]}

Karsten, Hartung ^{[36
,58
]}

Barabara, Hauptmeier ^{[37
]}

Matthias, Held ^{[38
]}

Frederik, Hempel ^{[39
]}

Iris, Hering ^{[40
]}

Carola, Hobler ^{[41
]}

Andreas, Hocke ^{[42
]}

Ursula, Hoffmann ^{[43
]}

Henning, Kahnert ^{[44
]}

Oliver, Kanwar ^{[45
]}

Lena, Kappauf ^{[46
]}

Charlotte, Keller ^{[47
]}

Nils, Keller ^{[48
]}

Walter, Knueppel ^{[49
]}

Eva, Koch ^{[50
]}

机构：

[1] Univ Leipzig, Inst Med Informat Stat & Epidemiol IMISE, Hartelstr 16-18, D-04107 Leipzig, Germany

[2] Charite Univ Med Berlin, Dept Infect Dis & Resp Med, Campus Virchowklinikum,Augustenburgerpl 1, D-13353 Berlin, Germany

[3] Free Univ Berlin, 2, Campus Virchowklinikum,Augustenburgerpl 1, D-13353 Berlin, Germany

[4] Humboldt Univ, 2, Campus Virchowklinikum,Augustenburgerpl 1, D-13353 Berlin, Germany

[5] Berlin Inst Hlth, 2, Campus Virchowklinikum,Augustenburgerpl 1, D-13353 Berlin, Germany

[6] HTW Dresden Univ Appl Sci, Fac Informat Math, Friedrich List Pl 1, D-01069 Dresden, Germany

[7] Jena Univ Hosp, Integrated Biobank Jena IBBJ, Klinikum 1, D-07740 Jena, Germany

[8] Inst Clin Chem & Lab Diagnost, 4, Klinikum 1, D-07740 Jena, Germany

[9] Univ Appl Sci, Life Sci Engn, Tech Hsch Mittelhessen, D-35390 Giessen, Germany

[10] Jena Univ Hosp, Dept Anesthesiol & Intens Care Med, Klinikum 1, D-07747 Jena, Germany

[11] Jena Univ Hosp, Ctr Clin Studies, Klinikum 1, D-07747 Jena, Germany

[12] Jena Univ Hosp, Dept Anesthesiol & Intens Care Med, 7, Klinikum 1, D-07747 Jena, Germany

[13] Jena Univ Hosp, Klinikum 1, D-07747 Jena, Germany

[14] Univ Med Greifswald, Interfac Inst Genet & Funct Gen, Dept Funct Genom, Felix Hausdorff Str 8, D-17475 Greifswald, Germany

[15] Univ Hosp Giessen, Inst Med Microbiol, Schubertstr 81, D-35392 Giessen, Germany

[16] Free Univ Berlin, Charitepl 1, D-10117 Berlin, Germany

[17] Humboldt Univ, Charitepl 1, D-10117 Berlin, Germany

[18] Berlin Inst Hlth, Charitepl 1, D-10117 Berlin, Germany

[19] Charite Univ Med Berlin, Klin Anasthesiol & Intens Therapie, Hindenburgdamm 30, D-12203 Berlin, Germany

[20] Krankenhaus Angermunde, Klin Innere Med Pneumol, Rudolf Breitscheid Str 37, D-16278 Angermunde, Germany

[21] Univ Klinikum Schleswig, Med 1,Arnold Heller Str 3, D-24105 Kiel, Germany

[22] Univ Klinikum Saarlandes, Innere Med 5, Kirrbergerstr Gebaude 91, D-66421 Homburg, Germany

[23] Charite Univ Med Berlin, Med Klin mS Infektiol & Pneumol, Charitepl1, D-10117 Berlin, Germany

[24] Mathias Spital Rheine, Med Klin 5, Klin Pneumol & Thoraxonkol, Frankenburgstr 31, D-48431 Rheine, Germany

[25] Univ Klinikum Jena, Klin Anasthesiol & Intens Therapie, Erlanger Allee 101, D-07747 Jena, Germany

[26] Evangel Kliniken Bonn, Betriebsstatte Johanniter Krankenhaus, Innere Med 2, Johanniterstr 3-5, D-53113 Bonn, Germany

[27] Univ Leipzig, Innere Med Neurol & Dermatol, Pneumol 62 2, Liebigstr 20, D-04103 Leipzig, Germany

[28] Mathias Spital Rheine, Klin Pneumol & Thoraxonkol, Med Klin 5, Frankenburgstr 31, D-48431 Rheine, Germany

[29] Christliches Krankenhaus Quakenbruck eV, Med Klin, Abtl Pneumol, Allergol,Schlafmed, Danziger Str 2, D-49610 Quakenbruck, Germany

[30] LKH Univ, Klinikum Graz, UKIM Pulmol, Auenbruggerpl 1, A-8036 Graz, Austria

[31] Charite Univ Med Berlin, Med Klin mS Infektiol & Pneumol, Augustenburgerpl 1, D-13353 Berlin, Germany

[32] Hannover Med Sch, Klin Pneumol, Carl Neuberg Str 1, D-30652 Hannover, Germany

[33] Charite Univ Med Berlin, CCM mS Infektiol & Pneumol, Charitepl 1, D-10117 Berlin, Germany

[34] Vivantes Klinikum Spandau, Kard Pneum & Kons Intens Med, Bergstr 6, D-13585 Berlin, Germany

[35] Kliniken d Main Taunus Kreises, Klin Pneumol Allg Innere Med, Lindenstr 10, D-65719 Hofheim, Germany

[36] Hartung Lungenklin Ballenstedt Harz gGmbH, Ev Fachkrankenhaus Lungenkrankheiten, Robert Koch Str 26-27, D-06493 Ballenstedt, Germany

[37] Berufsgenossenschaftl Univ Bergmannsheil GmbH, Klin Pneumol, Allergol Schlafmed, Burkle De La Camp Pl 1, D-44789 Bochum, Germany

[38] Klinikum Wurzburg Mitte Standort MissioKlin gGmbH, Med Klink mS Pneumol Beatmungsmed, Salvatorstr 7, D-97074 Wurzburg, Germany

[39] Klinikum Dortmund gGmbH, Med Klin Pneumol Infektiol, Munsterstr 240, D-44145 Dortmund, Germany

[40] Diakoniekrankenhaus Rotenburg Wumme gGmbH, Zentrum Pneumol, Elise Averdieck Str 17, D-27356 Rotenburg Wumme, Germany

[41] Kliniken d Main Taunus Kreises, Klin Pneumol Allg Innere Med, Lindenstr 10, D-65719 Hofheim, Germany

[42] Charite Univ Med Berlin, Medizin Klin mS Infektiol & Pneumol, Charitepl 1, D-10117 Berlin, Germany

[43] Univ Med Mannheim, Studienkoordinierungszentrum 1, Med Klin, Theodor Kutzer Ufer 1-3, D-68167 Mannheim, Germany

[44] Vivantes Klinikum Spandau, Kard Pneum & kons Intens Med, Neue Bergstr 6, D-13585 Berlin, Germany

[45] Evangel Kliniken Bonn, Betriebsstatte Johanniter Krankenhaus, Innere Med II, Johanniterstr 3-5, D-53113 Bonn, Germany

[46] Evangelisches Krankenhaus Kalk gGmbH, Innere Med Pneumol, Buchforststr 2, D-51103 Cologne, Germany

[47] Charite Univ Med Berlin, Med Klin mS Infektiol & Pneumol, Charitepl 1, D-10117 Berlin, Germany

[48] Klinikum St Georg gGmbH, Klin Infekt Tropenmed & Nephrol, Delitzscher Str 141, D-04129 Leipzig, Germany

[49] Krankenhaus Bad Arolsen GmbH, Innere Med Herz Kreislauf Lungendiagnost, Grosse Allee 50, D-34454 Bad Arolsen, Germany

[50] Univ Leipzig, Innere Med Neurol & Dermatol, Liebigstr 20, D-04103 Leipzig, Germany

来源：

CRITICAL CARE | 2019年 / 23卷 / 1期

关键词：

Clinical epidemiology; Biomarker; Severity score; Prospective clinical study; Infectious disease; Lung disease; INFLAMMATORY RESPONSE SYNDROME; CLINICAL STABILITY; PREDICTION RULE; RISK-FACTORS; SOFA SCORE; SEPSIS; VALIDATION; CRITERIA; MANAGEMENT; MORTALITY;

D O I：

10.1186/s13054-019-2316-x

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

BackgroundCAP (Community acquired pneumonia) is frequent, with a high mortality rate and a high burden on health care systems. Development of predictive biomarkers, new therapeutic concepts, and epidemiologic research require a valid, reproducible, and quantitative measure describing CAP severity.MethodsUsing time series data of 1532 patients enrolled in the PROGRESS study, we compared putative measures of CAP severity for their utility as an operationalization. Comparison was based on ability to correctly identify patients with an objectively severe state of disease (death or need for intensive care with at least one of the following: substantial respiratory support, treatment with catecholamines, or dialysis). We considered IDSA/ATS minor criteria, CRB-65, CURB-65, Halm criteria, qSOFA, PSI, SCAP, SIRS-Score, SMART-COP, and SOFA.ResultsSOFA significantly outperformed other scores in correctly identifying a severe state of disease at the day of enrollment (AUC=0.948), mainly caused by higher discriminative power at higher score values. Runners-up were the sum of IDSA/ATS minor criteria (AUC=0.916) and SCAP (AUC=0.868). SOFA performed similarly well on subsequent study days (all AUC>0.9) and across age groups. In univariate and multivariate analysis, age, sex, and pack-years significantly contributed to higher SOFA values whereas antibiosis before hospitalization predicted lower SOFA.ConclusionsSOFA score can serve as an excellent operationalization of CAP severity and is proposed as endpoint for biomarker and therapeutic studies.Trial registrationclinicaltrials.gov NCT02782013, May 25, 2016, retrospectively registered.

引用

页数：13

共 39 条

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