PT  - JOURNAL ARTICLE
AU  - Martin Kolditz
AU  - Santiago Ewig
AU  - Benjamin Klapdor
AU  - Hartwig Schütte
AU  - Johannes Winning
AU  - Jan Rupp
AU  - Norbert Suttorp
AU  - Tobias Welte
AU  - Gernot Rohde
TI  - Community-acquired pneumonia as medical emergency: predictors of early deterioration
AID  - 10.1136/thoraxjnl-2014-206744
DP  - 2015 Jun 01
TA  - Thorax
PG  - 551--558
VI  - 70
IP  - 6
4099  - http://thorax.bmj.com/content/70/6/551.short
4100  - http://thorax.bmj.com/content/70/6/551.full
SO  - Thorax2015 Jun 01; 70
AB  - Background Early organ dysfunction determines the prognosis of community-acquired pneumonia (CAP), and recognition of CAP as a medical emergency has been advocated. Objective To characterise patients with ‘emergency CAP’ and evaluate predictors for very early organ failure or death. Methods 3427 prospectively enrolled patients of the CAPNETZ cohort were included. Emergency CAP was defined as requirement for mechanical ventilation or vasopressor support (MV/VS) or death within 72 h and 7 days after hospital admission, respectively. To determine independent predictors, multivariate Cox regression was employed. The ATS/IDSA 2007 minor criteria were evaluated for prediction of emergency CAP in patients without immediate need of MV/VS. Results 140 (4%) and 173 (5%) patients presented with emergency CAP within 3 and 7 days, respectively. Hospital mortality of patients presenting without immediate need of MV/VS was highest. Independent predictors of emergency CAP were the presence of focal chest signs, home oxygen therapy, multilobar infiltrates, altered mental status and altered vital signs (hypotension, raised respiratory or heart rate, hypothermia). The ATS/IDSA 2007 minor criteria showed a high sensitivity and negative predictive value, whereas the positive predictive value was low. Reduction to 6 minor criteria did not alter accuracy. Conclusions Emergency CAP is a rare but prognostic relevant condition, mortality is highest in patients presenting without immediate need of MV/VS. Vital sign abnormalities and parameters indicating acute organ dysfunction are independent predictors, and the ATS/IDSA 2007 minor criteria show a high negative predictive value.