Abe Shuichi, Wannigama Dhammika Leshan
Department of Infectious Diseases and Infection Control, Yamagata Prefectural Central Hospital, Yamagata, JPN.
Cureus. 2024 Nov 7;16(11):e73201. doi: 10.7759/cureus.73201. eCollection 2024 Nov.
Background and aim , or pneumococcus, is one of the most common pathogens responsible for community-acquired pneumonia (CAP), which can progress to sepsis and lead to severe illness. Several clinical scoring systems are widely used to assess the severity of CAP and sepsis. This study aims to evaluate the clinical factors that predict mortality in pneumococcal CAP (pCAP). Methods Patients eligible for this study were 16 years or older and diagnosed with pCAP at Yamagata Prefectural Central Hospital, Yamagata, Japan, between January 2012 and May 2018. pCAP was defined by the single isolation of from sputum or blood culture in patients with CAP. Patients were divided into two groups based on 60-day mortality: survivors and non-survivors. Clinical parameters, including performance status (PS), were assessed for both groups. Disease severity was evaluated using the A-DROP, CURB-65, and quick Sequential Organ Failure Assessment (qSOFA) scores. Statistical analysis was performed using JMP 11 software (JMP Statistical Discovery LLC, NC, USA). Results A total of 192 patients (135 men and 57 women) were enrolled in this study. The median age was 77 years (range: 21-97 years). Among them, 169 patients were survivors and 22 were non-survivors. was more frequently detected in the blood cultures of non-survivors than survivors (27.3% vs. 7.7%, respectively; p = 0.01, chi-square test). Non-survivors exhibited poorer PS (PS ≥3), higher A-DROP scores (A-DROP ≥3), and higher qSOFA scores (qSOFA ≥2) compared to survivors (p = 0.002, 0.02, and 0.0003, chi-square test, respectively). However, there was no significant difference in the CURB-65 score between the two groups. Multivariate analysis revealed that higher qSOFA scores and poor PS were independent risk factors for 60-day mortality in pCAP (OR 4.0 (95% CI: 1.3-13.3) and 4.0 (1.4-10.9), respectively). Conclusions The qSOFA and PS scoring systems may be useful in predicting the prognosis of pCAP.
肺炎球菌是社区获得性肺炎（CAP）最常见的病原体之一，可进展为脓毒症并导致严重疾病。几种临床评分系统被广泛用于评估CAP和脓毒症的严重程度。本研究旨在评估预测肺炎球菌性CAP（pCAP）死亡率的临床因素。方法：本研究的入选患者年龄在16岁及以上，于2012年1月至2018年5月期间在日本山形县中央医院被诊断为pCAP。pCAP定义为CAP患者痰或血培养中肺炎球菌的单次分离。根据60天死亡率将患者分为两组：存活者和非存活者。对两组患者评估包括体能状态（PS）在内的临床参数。使用A-DROP、CURB-65和快速序贯器官衰竭评估（qSOFA）评分评估疾病严重程度。使用JMP 11软件（JMP Statistical Discovery LLC，美国北卡罗来纳州）进行统计分析。结果：本研究共纳入192例患者（135例男性和57例女性）。中位年龄为77岁（范围：21-97岁）。其中，169例患者存活，22例患者死亡。与存活者相比，非存活者血培养中肺炎球菌的检出频率更高（分别为27.3%和7.7%；p = 0.01，卡方检验）。与存活者相比，非存活者的PS更差（PS≥3）、A-DROP评分更高（A-DROP≥3）且qSOFA评分更高（qSOFA≥2）（分别为p = 0.002、0.02和0.0003，卡方检验）。然而，两组之间的CURB-65评分无显著差异。多因素分析显示，较高的qSOFA评分和较差的PS是pCAP患者60天死亡率的独立危险因素（OR分别为4.0（95%CI：1.3-13.3）和4.0（1.4-10.9））。结论：qSOFA和PS评分系统可能有助于预测pCAP的预后。
