Clinical question: Which parameters predict emergency CAP, defined as the requirement for mechanical ventilation (MV), vasopressor support (VS), or death within three to seven days?
Background: Major causes of short-term mortality in CAP include respiratory failure, septic shock, and decompensated co-morbidity. Studies have demonstrated that immediate interventions can have a substantial impact on outcomes; improving prognosis will require early recognition of CAP as a medical emergency.
Study design: Retrospective evaluation of prospective cohort study.
Setting: Hospitalized patients recruited from the multicenter, German Competence Network for the study of CAP (CAPNETZ).
Synopsis: Investigators included 3,427 patients; those who required immediate mechanical ventilation or presented in septic shock had significantly lower mortality rates than those who presented without immediate need for MV or VS. Using multivariate Cox regression, independent predictors for the development of emergency CAP within 72 hours were determined. The study also evaluated the ATS/IDA 2007 nine minor criteria for severe pneumonia in predicting emergency CAP.
Bottom line: Emergency CAP is rare but carries important prognostic considerations. Identifying those patients at risk for clinical deterioration could help in early identification and management of this subgroup of patients. Altered mental status and vital signs (hypotension, tachypnea, tachycardia, hypothermia), acute organ dysfunction, home O2, and multilobar infiltrates have been found to be independent predictors of emergency CAP. Regular evaluation of these parameters, coupled with established scores such as the ATS/IDSA 2007 minor criteria, should help guide management.
Citation: Kolditz, M, Ewig S, Klapdor B, et al. Community-acquired pneumonia as medical emergency: predictors of early deterioration. Thorax. 2015;70(6):551-558. doi:10.1136/thoraxjnl-2014-206744.