Abstract
Introduction: Patients with nursing home acquired pneumonia (NHAP) represent a distinct group of lower respiratory track infections with different risk factors, clinical presentation and mortality rates.
Aim: To evaluate the diagnostic value of clinical pulmonary infection score (CPIS), CRP and procalcitonin (PCT) and compare the accuracy of pneumonia severity scores (CURB-65, PSI, NHAP index, SMART-COP, SOAR) in predicting inpatient mortality of NHAP.
Methods: Nursing home residents admitted to hospital with acute respiratory illness were enrolled in the study. Subjects were classified as having NHAP (group A) or other pulmonary disorders (group B). Clinical, imaging and laboratory data were assessed to compute CPIS and severity scores. CRP and PCT were measured by immunonephelometry and immunoassay respectively.
Results: 58 subjects were diagnosed with NHAP (group A) and 29 with other pulmonary disorders (group B). Mean ± SD CRP was 16.38±8.6mg/dl in group A and 5.2±5.6mg/dl in group B (p<0.001). Mean ± SD PCT was 1.52 ±2.75ng/ml in group A and 0.24±0.21ng/ml in group B (p=0.001). Mean± SD CPIS was 5.4±1.2 in group A and 2.3±1.5 in group B (p<0.001). At cut-off value of 0.475ng/ml, PCT had sensitivity 83% and specificity 72%. At cut-off value of 8.05mg/dl, CRP had sensitivity 81% and specificity 79%. PCT and CRP levels were significantly higher in Gram (+) NHAP. The inpatient mortality was 17.2% in group A. PCT levels were 4.67±5.4ng/ml in non-survivors and 0.86 ±0.9ng/ml in survivors (p<0.001). Area under the curve (AUC) for PCT in predicting inpatient mortality was 0.84(95%CI 0.70-0.98, p=0.001). A PCT level on admission above 1.1ng/ml was an independent predictor of inpatient mortality. Amongst pneumonia severity scores CURB-65 showed greater accuracy in predicting inpatient mortality [AUC 0.68(95%CI 0.53-0.84, p=0.06)].
Conclusion: The CPIS, PCT and CRP are reliable for the diagnosis of NHAP. PCT and CURB-65 were accurate in predicting inpatient mortality in NHAP.
- Geriatrics/elderly patients/aging
- infections/infectious diseases/infection control
- severity of illness/scoring system
Footnotes
- Corresponding author: Ilias Porfyridis MD, PhD, Respiratory Physician, Pulmonary Department, Nicosia General Hospital, 215 Nicosia-Limassol Old Road, Strovolos 2029, Nicosia, Cyprus, ilias_porfi{at}yahoo.gr , Telephone: +35722604380, Fax: +35722604266
Conflict of interest: All the authors have no conflicts of interest to disclose
Financial support: None
- Copyright © 2013 by Daedalus Enterprises Inc.