ARTÍCULO DE INVESTIGACIÓN - Evaluación de los índices predictoresde eventos adversos en el adultoinmunocompetente hospitalizado porneumonía adquirida en la comunidad

Junio 2017

ARTÍCULO DE INVESTIGACIÓN 694 Rev Med Chile 2017; 145: 694-702 Evaluación de los índices predictores de eventos adversos en el adulto inmunocompetente hospitalizado por neumonía adquirida en la comunidad Fernando Saldías Peñafiel, Javier Uribe Monasterioa, Javiera Gassmann Poniachika, Alejandro Canelo Lópeza, Orlando Díaz Patiño Adverse event prediction in immunocompetent adult patients hospitalized with community- acquired pneumonia Background: Community-acquired pneumonia (CAP) causes significant morbidity and mortality in adults. Aim: To compare the accuracy of four validated rules for predicting adverse outcomes in patients hospitalized with CAP. Patients and Methods: We compared the pneumonia severity index (PSI), British Thoracic Society score (CURB-65), SMART-COP and severe CAP score (SCAP) in 659 immunocompetent adult patients aged 18 to 101 years, 52% male, hospitalized with CAP. Major adverse outcomes were: admission to ICU, need for mechanical ventilation (MV), in-hospital complications and 30-day mortality. Mean hospital length of stay (LOS) was also evaluated. The predictive indexes were compared based on sensitivity, specificity, and area under the curve of the receiver operating characteristic curve. Results: Of the studied patients, 77% had comorbidities, 23% were admitted to the intensive care unit and 12% needed mechanical ventilation. The rate of all adverse outcomes and hospital LOS increased directly with increasing PSI, CURB-65, SMART-COP and SCAP scores. The sensitivity, specificity and area under the curve of the prognostic indexes to predict adverse events were: Admission to ICU (PSI: 0.48, 0.84 and 0.73; SMART-COP: 0.97, 0.23 and 0.75; SCAP: 0.57, 0.81 and 0.76); use of MV (PSI: 0.44, 0.84 and 0.75; SMART-COP: 0.96, 0.35 and 0.84; SCAP: 0.53, 0.87 and 0.78); 30-days mortality (PSI: 0.45, 0.97 and 0.83; SMART-COP: 0.94, 0.29 and 0.77; SCAP: 0.53, 0.95 and 0.81). CURB-65 had a lower discriminatory power compared to the other indices. Conclusions: PSI score and SCAP were more accurate and specific and SMART-COP was more sensitive to predict the risk of death. SMART-COP was more sensitive and SCAP was more specific in predicting the use of mechanical ventilation. (Rev Med Chile 2017; 145: 694-702) Key words: Mortality; Pneumonia; Prognosis; Severity of Illness Index. Departamento de Enfermedades Respiratorias, División de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile. Santiago, Chile. aAlumnos de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile. Santiago, Chile. Recibido el 23 de marzo de 2017, aceptado el 27 de junio de 2017. Fuente de financiamiento: Proyecto Interdepartamental de la Facultad de Medicina, Pontificia Universidad Católica de Chile. Los autores no declaran conflictos de intereses. Correspondencia a: Dr. Fernando Saldías Peñafiel Departamento de Enfermedades Respiratorias División de Medicina-Facultad de Medicina Pontificia Universidad Católica de Chile. Diagonal Paraguay 362, Santiago, Chile. Teléfonos: (562) 26331541 - (562) 23543242 Fax: (562) 26335255 fsaldias@med.puc.cl 5864 La neumonía adquirida en la comunidad (NAC) ocasiona morbilidad y mortalidad significativa en el mundo, siendo la primera causa de muerte de causa infecciosa, con una incidencia estimada de 1.600 casos por 100.000 habitantes1-5. Se estima que 20-40% de los pacientes con neumonía requieren hospitalización6. La mortalidad de la neumonía fluctúa entre 5-10% y aumenta significativamente en el paciente hospitalizado, en el adulto mayor con comorbilidad múl


Junio 2017
To see the actual publication please follow the link above