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Research ArticleOriginal Research

Including Organ Dysfunctions in a Predictive Score for Nosocomial Pneumonia After Cardiothoracic Surgery

Talna Kortchinsky, Thibaut Genty, Anne Gigandon, Calypso Roman, Saida Rézaiguia-Delclaux and François Stéphan
Respiratory Care December 2022, 67 (12) 1558-1567; DOI: https://doi.org/10.4187/respcare.09911
Talna Kortchinsky
Cardiothoracic Intensive Care Unit, Marie Lannelongue Hospital, Le Plessis Robinson, France.
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Thibaut Genty
Cardiothoracic Intensive Care Unit, Marie Lannelongue Hospital, Le Plessis Robinson, France.
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Anne Gigandon
Bacteriology Laboratory, Marie Lannelongue Hospital, Le Plessis Robinson, France.
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Calypso Roman
Cardiothoracic Intensive Care Unit, Marie Lannelongue Hospital, Le Plessis Robinson, France.
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Saida Rézaiguia-Delclaux
Cardiothoracic Intensive Care Unit, Marie Lannelongue Hospital, Le Plessis Robinson, France.
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François Stéphan
Cardiothoracic Intensive Care Unit, Marie Lannelongue Hospital, Le Plessis Robinson, France; and Paris Saclay University, School of Medicine, Le Kremlin Bicêtre, France.
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  • For correspondence: [email protected]
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Abstract

BACKGROUND: Clinical diagnosis of ICU-acquired pneumonia after cardiothoracic surgery is challenging. Johanson criteria (chest radiograph infiltrate, purulent tracheal secretions, fever, and leukocytosis) fail in half the cases. A high Clinical Pulmonary Infection Score (CPIS) and ≥ 2-point increase in Sequential Organ Failure Assessment (SOFA) score (SOFA↑ ≥ 2) may improve diagnosis. The aim of the study was to evaluate whether CPIS or SOFA↑ ≥ 2 contributes to predict ICU-acquired pneumonia in subjects after cardiothoracic surgery.

METHODS: We used a prospective observational design. Spiegelhalter-Knill-Jones scoring systems including CPIS or SOFA↑ ≥ 2, together with other clinical and laboratory variables, were developed in a derivation cohort. A positive quantitative pulmonary sample culture was required to confirm ICU-acquired pneumonia. Area under the receiver operating characteristic curve (AUROC) was computed for each of the 2 scoring systems. The best system was evaluated in a validation cohort.

RESULTS: Derivation and validation cohorts included 172 and 108 subjects, with 410 and 216 suspected ICU-acquired pneumonia episodes, respectively. AUROC was 0.53 ± 0.03 for CPIS (P = .29) and 0.54 ± 0.03 for SOFA↑ ≥ 2 (P = .29). Adding purulent tracheal secretions and leukocytosis to SOFA↑ ≥ 2 (SOFA model) increased AUROC to 0.65 ± 0.03 (P < .001). Adding catecholamine use to CPIS (CPIS model) increased AUROC only slightly, to 0.57 ± 0.03. The probabilities predicted by the SOFA model were reliable, especially when high or low.

CONCLUSIONS: A clinical scoring system including at least SOFA↑ ≥ 2 increase barely improved ICU-acquired pneumonia prediction in subjects after cardiothoracic surgery.

  • hospital-acquired pneumonia
  • nosocomial pneumonia
  • sepsis
  • SOFA score
  • CPIS
  • prediction model development

Footnotes

  • Correspondence: François Stéphan MD PhD, Réanimation adulte, Hôpital Marie Lannelongue, 133 Avenue de la Résistance, 92350 Le Plessis Robinson, France. E-mail: f.stephan{at}ghpsj.fr
  • The authors have disclosed no conflicts of interest.

  • Supplementary material related to this paper is available at http://rcjournal.com.

  • Copyright © 2022 by Daedalus Enterprises
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Respiratory Care: 67 (12)
Respiratory Care
Vol. 67, Issue 12
1 Dec 2022
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Including Organ Dysfunctions in a Predictive Score for Nosocomial Pneumonia After Cardiothoracic Surgery
Talna Kortchinsky, Thibaut Genty, Anne Gigandon, Calypso Roman, Saida Rézaiguia-Delclaux, François Stéphan
Respiratory Care Dec 2022, 67 (12) 1558-1567; DOI: 10.4187/respcare.09911

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Including Organ Dysfunctions in a Predictive Score for Nosocomial Pneumonia After Cardiothoracic Surgery
Talna Kortchinsky, Thibaut Genty, Anne Gigandon, Calypso Roman, Saida Rézaiguia-Delclaux, François Stéphan
Respiratory Care Dec 2022, 67 (12) 1558-1567; DOI: 10.4187/respcare.09911
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Keywords

  • hospital-acquired pneumonia
  • nosocomial pneumonia
  • sepsis
  • SOFA score
  • CPIS
  • prediction model development

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