Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.
Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.
Infection. 2024 Apr;52(2):447-459. doi: 10.1007/s15010-023-02101-z. Epub 2023 Nov 20.
Risk scores for community-acquired pneumonia (CAP) are widely used for standardized assessment in immunocompetent patients and to identify patients at risk for severe pneumonia and death. In immunocompromised patients, the prognostic value of pneumonia-specific risk scores seems to be reduced, but evidence is limited. The value of different pneumonia risk scores in kidney transplant recipients (KTR) is not known.
Therefore, we retrospectively analyzed 310 first CAP episodes after kidney transplantation in 310 KTR. We assessed clinical outcomes and validated eight different risk scores (CRB-65, CURB-65, DS-CRB-65, qSOFA, SOFA, PSI, IDSA/ATS minor criteria, NEWS-2) for the prognosis of severe pneumonia and in-hospital mortality. Risk scores were assessed up to 48 h after admission, but always before an endpoint occurred. Multiple imputation was performed to handle missing values.
In total, 16 out of 310 patients (5.2%) died, and 48 (15.5%) developed severe pneumonia. Based on ROC analysis, sequential organ failure assessment (SOFA) and national early warning score 2 (NEWS-2) performed best, predicting severe pneumonia with AUC of 0.823 (0.747-0.880) and 0.784 (0.691-0.855), respectively.
SOFA and NEWS-2 are best suited to identify KTR at risk for the development of severe CAP. In contrast to immunocompetent patients, CRB-65 should not be used to guide outpatient treatment in KTR, since there is a 7% risk for the development of severe pneumonia even in patients with a score of zero.
社区获得性肺炎（CAP）风险评分广泛用于免疫功能正常患者的标准化评估，以识别发生重症肺炎和死亡的风险患者。在免疫功能低下的患者中，肺炎特异性风险评分的预后价值似乎降低，但证据有限。不同肺炎风险评分在肾移植受者（KTR）中的价值尚不清楚。
因此，我们回顾性分析了 310 例 KTR 中 310 例首次 CAP 发作。我们评估了临床结局，并验证了 8 种不同的风险评分（CRB-65、CURB-65、DS-CRB-65、qSOFA、SOFA、PSI、IDSA/ATS 次要标准、NEWS-2）对重症肺炎和住院死亡率的预后价值。风险评分在入院后 48 小时内进行评估，但始终在出现终点之前进行。采用多重插补处理缺失值。
总共 310 例患者中有 16 例（5.2%）死亡，48 例（15.5%）发生重症肺炎。基于 ROC 分析，序贯器官衰竭评估（SOFA）和国家早期预警评分 2（NEWS-2）表现最佳，预测重症肺炎的 AUC 分别为 0.823（0.747-0.880）和 0.784（0.691-0.855）。
SOFA 和 NEWS-2 最适合识别发生重症 CAP 的 KTR 风险。与免疫功能正常的患者不同，CRB-65 不应用于指导 KTR 的门诊治疗，因为即使评分零的患者也有 7%发生重症肺炎的风险。
