Assessing Severity of Patients with Community-Acquired Pneumonia

Jose Manuel Pereira; Jose Artur Paiva; Jordi Rello

doi:10.1055/s-0032-1315639

Seminars in Respiratory and Critical Care Medicine, Table of Contents

Semin Respir Crit Care Med 2012; 33(03): 272-283
DOI: 10.1055/s-0032-1315639

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Assessing Severity of Patients with Community-Acquired Pneumonia

Jose Manuel Pereira

¹Emergency and Intensive Care Department, Centro Hospitalar S. João EPE, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.

,

Jose Artur Paiva

¹Emergency and Intensive Care Department, Centro Hospitalar S. João EPE, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.

,

Jordi Rello

²Critical Care Department, Vall d'Hebron University Hospital, Institut de Recerca Vall d'Hebron, CIBERes, Universitat Autonoma Barcelona, Barcelona, Spain.

› Author Affiliations

Abstract

Despite all advances in its management, community-acquired pneumonia (CAP) is still an important cause of morbidity and mortality requiring a great consumption of health, social, and economic resources. An early and adequate severity assessment is of paramount importance to provide optimized care to these patients. In the last 2 decades, this issue has been the subject of extensive research. Based on 30 day mortality, several prediction rules have been proposed to aid clinicians in deciding on the appropriate site of care. In spite of being well validated, their sensitivity and specificity vary, which limits their widespread use. The utility of biomarkers to overcome this problem has been investigated. At this moment, their full clinical value remains undetermined, and no single biomarker is consistently ideal for assessing CAP severity. Biomarkers should be seen as a complement rather than superseding clinical judgment or validated clinical scores. The search for a gold standard is not over, and new tools, like bacterial DNA load, are in the pipeline. Until then, CAP severity assessment should be based in three key points: a pneumonia-specific score, biomarkers, and clinical judgment.

Keywords

severity - community-acquired pneumonia - scores - biomarkers - bacterial load - DNAemia

Full Text

References

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