J Korean Med Sci.  2012 Aug;27(8):907-913. 10.3346/jkms.2012.27.8.907.

Minor Criteria of Infectious Disease Society of America/American Thoracic Society for Severe Community-Acquired Pneumonia Can Predict Delayed Treatment Response

• Park SY
• Park S
• Lee MG
• Kim DG
• Suh GY
• Kim C
• Lee CY
• Park YB
• Jung KS

• KMID: 1714203
• DOI: http://doi.org/10.3346/jkms.2012.27.8.907

Abstract

The purpose of this study was to investigate the clinical aspects of patients satisfying the Infectious Disease Society of America/American Thoracic Society (IDSA/ATS) minor severity criteria, focusing on their treatment response to empirical antibiotics. In total, 381 community-acquired pneumonia (CAP) patients who did not require mechanical ventilation or vasopressors at admission were enrolled, and 50 (13.1%) satisfied the minor severity criteria (i.e. , minor severe CAP [minor-SCAP]). The rates of new complication events and clinical treatment failure were significantly higher in the minor-SCAP group than in the control group (30.0% vs 2.1%, P < 0.001, and 42.0% vs 10.6%, P < 0.001, respectively), and the time to reach clinical stability was longer in the minor-SCAP group (8 days vs 3 days, P < 0.001). In a multivariate model, minor severity criteria (> or = 3) were significantly associated with treatment failure (odds ratio, 2.838; 95% confidence interval, 1.216 to 6.626), and for predicting treatment failure the value of the area under the receiver operating characteristic curve for minor criteria was 0.731, similar to other established scoring methods. The IDSA/ATS minor severity criteria can predict delayed treatment response and clinical treatment failure.

Keyword

Minor Criteria; Pneumonia; Severe; Treatment Response

MeSH Terms

Adult
Aged
Anti-Bacterial Agents/therapeutic use
Area Under Curve
Community-Acquired Infections/*diagnosis/drug therapy/mortality
Female
Hospital Mortality
Humans
Intensive Care Units
Kaplan-Meier Estimate
Length of Stay
Male
Middle Aged
Odds Ratio
Pneumonia/*diagnosis/drug therapy/mortality
Predictive Value of Tests
ROC Curve
*Severity of Illness Index
Anti-Bacterial Agents

Figure

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  Fig. 1 Flowchart of the patient population. CAP, community-acquired pneumonia; ICU, intensive care unit; NTM, nontuberculous mycobacteria.

• 

  Fig. 2 Kaplan-Meier survival curves for the time to reach clinical stability. The time to reach clinical stability was longer in the minor-SCAP than in the control (i.e., non-SCAP) groups (log rank = 28.6, P < 0.001).

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  Fig. 3 ROC curves for prediction of clinical treatment failure. The AUC values for the minor criteria, CURB-65 and PSI scores were 0.731 (95% CI, 0.660-0.802), 0.688 (95% CI, 0.614-0.762), and 0.751 (95% CI, 0.688-0.814), respectively.

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