Carlos Pedro, Gomes Ricardo, Coelho Joana, Chaves Catarina, Tuna Célia, Louro Marlene
Internal Medicine Department, Centro Hospitalar Universitário Cova da Beira, Covilhã, PRT.
Endocrinology Department, Centro Hospitalar Tâmega e Sousa, Penafiel, PRT.
Cureus. 2023 Mar 12;15(3):e36052. doi: 10.7759/cureus.36052. eCollection 2023 Mar.
Background Community-acquired pneumonia remains a significant factor in global mortality. Several clinical scoring models are used for predicting pneumonia severity and mortality, aiding in the clinical decision relative to the therapeutic approach, including the CURB-65 score. However, currently, no models exist to identify high-risk patients relative to long-term prognosis when recent evidence reveals a significantly higher mortality rate in the first year after community-acquired pneumonia (CAP) hospitalization. Purpose of the study The purpose of this study is to evaluate the application of the CURB-65 scoring model in our population and examine its potential to predict prognosis and subsequent mortality 6 months after hospitalization. Other potential factors influencing mortality during and after hospitalization were characterized: patient demographics, nosocomial infections, readmissions, and identified pathogens. Study design We conducted a retrospective observational study, enrolling 130 patients admitted with a diagnosis of CAP in the department of internal medicine of Centro Hospitalar Universitário Cova da Beira between January and December of 2018. Consultation of electronic medical records was used to calculate the CURB-65 score on admission at the first hospitalization by CAP, categorizing patients into five risk groups. Mortality and readmission were evaluated after 30, 90, and 180 days. Key results High-risk patients (CURB>2) accounted for 96.9% of our study population. Inpatient mortality of 13%, increasing to 21.5% after six months, was similar to previous studies and was correlated to the CURB-65 score on admission. A microbiologic agent was identified in 37% of cases, with 53% isolates of Streptococcus (S.) pneumoniae. Conclusions Identifying high-risk patients is important for more individualized healthcare and management. The CURB-65 score, only validated for a short-term (30 days) prediction, demonstrates a potential to also predict mortality and rehospitalization in the six-month period after hospitalization, as supported by our findings and previous studies.
背景 社区获得性肺炎仍然是全球死亡率的一个重要因素。几种临床评分模型用于预测肺炎的严重程度和死亡率，有助于临床决策制定治疗方案，包括CURB-65评分。然而，目前尚无模型用于识别社区获得性肺炎（CAP）住院后第一年死亡率显著更高的情况下与长期预后相关的高危患者。研究目的 本研究旨在评估CURB-65评分模型在我们的研究人群中的应用，并检验其预测住院后6个月预后和后续死亡率的潜力。还对影响住院期间及出院后死亡率的其他潜在因素进行了特征分析：患者人口统计学特征、医院感染、再入院情况以及鉴定出的病原体。研究设计 我们进行了一项回顾性观察研究，纳入了2018年1月至12月在贝拉大学中心医院内科诊断为CAP的130例患者。通过查阅电子病历计算首次因CAP住院时的CURB-65评分，将患者分为五个风险组。在30天、90天和180天后评估死亡率和再入院情况。主要结果 高危患者（CURB>2）占我们研究人群的96.9%。住院死亡率为13%，6个月后升至21.5%，与先前研究相似，且与入院时的CURB-65评分相关。37%的病例鉴定出微生物病原体，其中53%的分离株为肺炎链球菌。结论 识别高危患者对于更个性化的医疗保健和管理很重要。CURB-65评分仅在短期（30天）预测中得到验证，但我们的研究结果和先前研究均表明，它也有潜力预测住院后6个月内的死亡率和再住院情况。
