SMART-COP: A tool for predicting the need for intensive respiratory or vasopressor support in community-acquired pneumonia

被引:354
作者
Charles, Patrick G. P. [1 ,3 ]
Wolfe, Rory [4 ]
Whitby, Michael [7 ]
Fine, Michael J. [14 ,15 ]
Fuller, Andrew J. [9 ]
Stirling, Robert [10 ]
Wright, Alistair A. [11 ]
Ramirez, Julio A. [16 ]
Christiansen, Keryn J. [12 ]
Waterer, Grant W. [13 ]
Pierce, Robert J. [2 ]
Armstrong, John G. [8 ]
Korman, Tony M. [5 ]
Holmes, Peter [6 ]
Obrosky, D. Scott [15 ]
Peyrani, Paula [16 ]
Johnson, Barbara [7 ]
Hooy, Michelle [10 ]
Grayson, M. Lindsay [1 ,3 ,4 ]
机构
[1] Austin Hlth, Dept Infect Dis, Heidelberg, Vic 3084, Australia
[2] Austin Hlth, Dept Resp & Sleep Med, Heidelberg, Vic 3084, Australia
[3] Univ Melbourne, Dept Med, Parkville, Vic 3052, Australia
[4] Monash Univ, Dept Epidemiol & Prevent Med, Clayton, Vic, Australia
[5] Monash Med Ctr, Dept Infect Dis, Clayton, Vic 3168, Australia
[6] Monash Med Ctr, Dept Resp Med, Clayton, Vic 3168, Australia
[7] Princess Alexandra Hosp, Dept Infect Dis, Woolloongabba, Qld 4102, Australia
[8] Princess Alexandra Hosp, Dept Resp Med, Woolloongabba, Qld 4102, Australia
[9] Alfred Hosp, Dept Infect Dis, Prahran, Vic 3181, Australia
[10] Alfred Hosp, Dept Resp Med, Prahran, Vic 3181, Australia
[11] W Gippsland Hosp, Warragul, Australia
[12] Royal Perth Hosp, Dept Microbiol & Infect Dis, PathWest Lab Med, Perth, WA, Australia
[13] Royal Perth Hosp, Dept Resp Med, Perth, WA, Australia
[14] Univ Pittsburgh, Div Gen Internal Med, Pittsburgh, PA USA
[15] VA Pittsburgh Healthcare Syst, Ctr Healthcare Equ Res & Promot, Pittsburgh, PA USA
[16] Univ Louisville, Div Infect Dis, Louisville, KY 40292 USA
关键词
D O I
10.1086/589754
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background. Existing severity assessment tools, such as the pneumonia severity index (PSI) and CURB-65 (tool based on confusion, urea level, respiratory rate, blood pressure, and age >= 65 years), predict 30-day mortality in community-acquired pneumonia (CAP) and have limited ability to predict which patients will require intensive respiratory or vasopressor support (IRVS). Methods. The Australian CAP Study (ACAPS) was a prospective study of 882 episodes in which each patient had a detailed assessment of severity features, etiology, and treatment outcomes. Multivariate logistic regression was performed to identify features at initial assessment that were associated with receipt of IRVS. These results were converted into a simple points-based severity tool that was validated in 5 external databases, totaling 7464 patients. Results. In ACAPS, 10.3% of patients received IRVS, and the 30-day mortality rate was 5.7%. The features statistically significantly associated with receipt of IRVS were low systolic blood pressure (2 points), multilobar chest radiography involvement (1 point), low albumin level (1 point), high respiratory rate (1 point), tachycardia (1 point), confusion (1 point), poor oxygenation (2 points), and low arterial pH (2 points): SMART-COP. A SMART-COP score of >= 3 points identified 92% of patients who received IRVS, including 84% of patients who did not need immediate admission to the intensive care unit. Accuracy was also high in the 5 validation databases. Sensitivities of PSI and CURB-65 for identifying the need for IRVS were 74% and 39%, respectively. Conclusions. SMART-COP is a simple, practical clinical tool for accurately predicting the need for IRVS that is likely to assist clinicians in determining CAP severity.
引用
收藏
页码:375 / 384
页数:10
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