Division of Pulmonology, Medical Dept 1, University Hospital Carl Gustav Carus, Dresden, Germany.
Eur Respir J. 2013 Apr;41(4):974-84. doi: 10.1183/09031936.00104412. Epub 2012 Sep 27.
Community-acquired pneumonia (CAP) represents a major life-threatening infection, but disease course and outcome is highly variable. Major drivers of prognosis are respiratory failure, sepsis-related organ dysfunction and unstable comorbidities. Current risk stratification tools have been primarily designed to predict mortality and identify low risk patients potentially suitable for ambulatory management. Detection of patients at high risk for clinical deterioration by current scores remains suboptimal. Therefore, management-related risk stratification tools designed to predict benefit from early intensified monitoring and treatment strategies in hospitalised CAP are advocated. An approach including early and repeatedly evaluated clinical markers of respiratory failure, sepsis-related organ dysfunction or decompensating comorbidity combined with individual definition of treatment goals is suggested. Inflammatory biomarkers can add prognostic information. New cardiovascular or stress-related biomarkers like copeptin, midregional proadrenomedullin and cortisol have been repeatedly linked with outcome and disease course in CAP and improved clinical scoring in observational studies. Thus they represent promising tools for individualised risk stratification. A major task in future CAP research will be the evaluation of their additional value in large interventional trials with control groups incorporating strict management guidance by clinical criteria.
社区获得性肺炎（CAP）是一种严重的危及生命的感染，但疾病的过程和结果变化很大。预后的主要驱动因素是呼吸衰竭、与脓毒症相关的器官功能障碍和不稳定的合并症。目前的风险分层工具主要用于预测死亡率和识别可能适合门诊管理的低危患者。目前的评分系统对检测病情恶化风险高的患者的效果仍不理想。因此，提倡使用旨在预测从住院 CAP 中早期强化监测和治疗策略中获益的与管理相关的风险分层工具。建议采用一种方法，包括早期和反复评估呼吸衰竭、与脓毒症相关的器官功能障碍或失代偿性合并症的临床标志物，并结合个体治疗目标的定义。炎症生物标志物可以提供预后信息。新的心血管或应激相关生物标志物，如 copeptin、中区域 proadrenomedullin 和皮质醇，已在 CAP 中与预后和疾病过程反复相关，并在观察性研究中改善了临床评分。因此，它们是个体化风险分层的有前途的工具。未来 CAP 研究的一项主要任务是评估它们在具有对照组的大型干预试验中的附加价值，对照组纳入了严格的临床标准管理指导。
