Prediction model for pneumonia in primary care patients with an acute respiratory tract infection: role of symptoms, signs, and biomarkers

被引:14
作者
Groeneveld, G. H. [1 ]
van't Wout, J. W. [1 ]
Aarts, N. J. [2 ]
van Rooden, C. J. [3 ]
Verheij, T. J. M. [4 ]
Cobbaert, C. M. [5 ]
Kuijper, E. J. [6 ]
de Vries, J. J. C. [6 ]
van Dissel, J. T. [7 ,8 ]
机构
[1] Leiden Univ, Med Ctr, Dept Internal Med & Infect Dis, POB 9600, NL-2300 RC Leiden, Netherlands
[2] HMC Bronovo, Dept Radiol, POB 432, NL-2501 CK The Hague, Netherlands
[3] HAGA Hosp, Dept Radiol, POB 40551, NL-2504 LN The Hague, Netherlands
[4] Univ Med Ctr Utrecht, Julius Ctr Hlth Sci & Primary Care, POB 85500, NL-3508 GA Utrecht, Netherlands
[5] Leiden Univ, Med Ctr, Dept Clin Chem & Lab Med, POB 9600, NL-2300 RC Leiden, Netherlands
[6] Leiden Univ, Med Ctr, Dept Med Microbiol, POB 9600, NL-2300 RC Leiden, Netherlands
[7] RIVM, Natl Inst Publ Hlth & Environm, Ctr Infect Dis Control, Bilthoven, Netherlands
[8] Leiden Univ, Dept Infect Dis, Med Ctr, Leiden, Netherlands
关键词
Respiratory tract infection; Pneumonia; Primary care; Biomarkers; Prediction model; CRP; Antibiotic; Chest X ray; COMMUNITY-ACQUIRED PNEUMONIA; C-REACTIVE PROTEIN; RADIOGRAPHIC RESOLUTION; PROCALCITONIN; AMOXICILLIN; DIAGNOSIS; ADULTS;
D O I
10.1186/s12879-019-4611-1
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Background: Diagnosing pneumonia can be challenging in general practice but is essential to distinguish from other respiratory tract infections because of treatment choice and outcome prediction. We determined predictive signs, symptoms and biomarkers for the presence of pneumonia in patients with acute respiratory tract infection in primary care. Methods: From March 2012 until May 2016 we did a prospective observational cohort study in three radiology departments in the Leiden-The Hague area, The Netherlands. From adult patients we collected clinical characteristics and biomarkers, chest X ray results and outcome. To assess the predictive value of C-reactive protein (CRP), procalcitonin and midregional pro-adrenomedullin for pneumonia, univariate and multivariate binary logistic regression were used to determine risk factors and to develop a prediction model. Results: Two hundred forty-nine patients were included of whom 30 (12%) displayed a consolidation on chest X ray. Absence of runny nose and whether or not a patient felt ill were independent predictors for pneumonia. CRP predicts pneumonia better than the other biomarkers but adding CRP to the clinical model did not improve classification (- 4%); however, CRP helped guidance of the decision which patients should be given antibiotics. Conclusions: Adding CRP measurements to a clinical model in selected patients with an acute respiratory infection does not improve prediction of pneumonia, but does help in giving guidance on which patients to treat with antibiotics. Our findings put the use of biomarkers and chest X ray in diagnosing pneumonia and for treatment decisions into some perspective for general practitioners.
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页数:9
相关论文
共 32 条
[1]   Prognostic power of proadrenomedullin in community-acquired pneumonia is independent of aetiology [J].
Bello, Salvador ;
Lasierra, Ana B. ;
Minchole, Elisa ;
Fandos, Sergio ;
Angeles Ruiz, Maria ;
Vera, Elisabeth ;
de Pablo, Francisco ;
Ferrer, Miguel ;
Menendez, Rosario ;
Torres, Antoni .
EUROPEAN RESPIRATORY JOURNAL, 2012, 39 (05) :1144-1155
[2]  
Brookes-Howell L, 2012, BMJ OPEN, V2, P3
[3]   THE EFFECT OF CHEST RADIOGRAPHS ON THE MANAGEMENT AND CLINICAL COURSE OF PATIENTS WITH ACUTE COUGH [J].
BUSHYHEAD, JB ;
WOOD, RW ;
TOMPKINS, RK ;
WOLCOTT, BW ;
DIEHR, P .
MEDICAL CARE, 1983, 21 (07) :661-673
[4]   Pro-adrenomedullin to predict severity and outcome in community-acquired pneumonia [ISRCTN04176397] [J].
Christ-Crain, Mirjam ;
Morgenthaler, Nils G. ;
Stolz, Daiana ;
Mueller, Christian ;
Bingisser, Roland ;
Harbarth, Stephan ;
Tamm, Michael ;
Struck, Joachim ;
Bergmann, Andreas ;
Mueller, Beat .
CRITICAL CARE, 2006, 10 (03)
[5]   C-reactive protein and community-acquired pneumonia in ambulatory care: systematic review of diagnostic accuracy studies [J].
Falk, Gavin ;
Fahey, Tom .
FAMILY PRACTICE, 2009, 26 (01) :10-21
[6]   CICADA: Cough in Children and Adults: Diagnosis and Assessment. Australian Cough Guidelines summary statement [J].
Gibson, Peter G. ;
Chang, Anne B. ;
Glasgow, Nicholas J. ;
Holmes, Peter W. ;
Katelaris, Peter ;
Kemp, Andrew S. ;
Landau, Louis I. ;
Mazzone, Stuart ;
Newcombe, Peter ;
Van Asperen, Peter ;
Vertigan, Anne E. .
MEDICAL JOURNAL OF AUSTRALIA, 2010, 192 (05) :265-+
[7]  
Graffelman AW, 2004, BRIT J GEN PRACT, V54, P15
[8]   Clinical factors, C-reactive protein point of care test and chest X-ray in patients with pneumonia: A survey in primary care [J].
Groeneveld, Geert H. ;
van de Peppel, Robert J. ;
de Waal, Margot W. M. ;
Verheij, Theo J. M. ;
van Dissel, Jaap T. .
EUROPEAN JOURNAL OF GENERAL PRACTICE, 2019, 25 (04) :229-235
[9]  
Holm A, 2007, BRIT J GEN PRACT, V57, P555
[10]  
Hopstaken RM, 2003, BRIT J GEN PRACT, V53, P358