Artikel
Validation of the qSOFA(-65) compared to the CRB-65 score in a large cohort of CAP patients
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Autoren
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Miriam Kesselmeier
- Clinical Epidemiology, Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany
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Mathias Pletz
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
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Anna Leona Blankenstein
- Division of Pulmonology, Medical Department I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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André Scherag
- Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Jena, Germany
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Torsten Bauer
- Department of Pneumology, Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring, Berlin, Germany
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Santiago Ewig
- Thoraxzentrum Ruhrgebiet, Department of Respiratory and Infectious Diseases, EVK Herne and Augusta-Kranken-Anstalt Bochum, Bochum, Germany
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Martin Kolditz
- Division of Pulmonology, Medical Department I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| Veröffentlicht: | 26. Februar 2021 |
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Gliederung
Text
Background: Community-acquired pneumonia (CAP) carries a highly variable prognosis with mortality rates ranging from 1% to 40% depending on age, severity and comorbidities [1]. Therefore, risk scoring to guide further treatment decisions is the recommended first management step. Initial assessment may include a screening score consisting of the easily evaluable CRB-65 criteria [2], [3], followed by organ dysfunction evaluation in high risk patients. The quick Sequential [Sepsis-related] Organ Failure Assessment (qSOFA) score [4], [5] includes similar variables as those included in the CRB-65 pneumonia score. Despite the fact that it was not its original purpose, the prognostic accuracy of the qSOFA in patients with CAP has not been extensively evaluated [6]. The aim was to validate the qSOFA score with and without considering age in a large cohort of CAP patients.
Methods: We included all cases with CAP hospitalised between 2014 and 2018 from the German nationwide mandatory quality assurance program [7]. We excluded cases transferred from another hospital, on mechanical ventilation during admission and without documented respiratory rate. Predefined binary outcomes were hospital mortality and need of mechanical ventilation. We applied multivariable logistic regression modelling for all outcomes including the CRB-65 or the qSOFA score as independent variables. Furthermore, we evaluated diagnostic properties.
Results: Among the 1,262,250 included CAP cases hospital mortality was 12.4% and mechanical ventilation rate 7.1%. All CRB and qSOFA criteria were associated with both outcomes. Including the age criterion ≥65 years, CRB-65 and the modified qSOFA-65 performed similarly for hospital mortality prediction (AUC 0.68 versus 0.69). A qSOFA-65 of 0 was associated with fewer missed deaths (3,328, 2.0%) compared to a CRB-65 of 0 (5,480, 2.4%). The sensitivity of the suggested qSOFA cut-off of ≥2 for suspected sepsis was low (mortality: 25.8%, mechanical ventilation: 24.1%), but any positive CRB or qSOFA criterion was associated with a positive likelihood ratio of >1.5 for both outcomes. Results were similar when excluding frail and palliative patients.
Conclusion: The qSOFA showed prognostic accuracy similar to the CRB in CAP, but the cut-off for suspected sepsis of ≥2 lacked sensitivity. For sensitive hospital mortality prediction, the age criterion ≥65 years should be added to the qSOFA; ideally age should enter the model as quantitative variable.
The authors declare that they have no competing interests.
The authors declare that an ethics committee vote is not required.
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