Revisión clínica
Published on 13 de diciembre de 2023 | http://doi.org/10.5867/medwave.2023.11.2719
Community-acquired pneumonia: Epidemiology, diagnosis, prognostic severity scales, and new therapeutic options
| IDSA/ATS 2007 | Minor criteria show good discriminatory power for mortality or admission to the intensive care unit. Some criteria, such as hypoxemia, confusion, and arterial hypotension, are more discriminatory than others but receive the same number of points. | |
| Simplified IDSA/ATS 2007 | Respiratory rate ≥ 30 per minute, PaO2/FiO2 ratio < 250, multilobar infiltrate, confusion/disorientation, urea ≥ 50 mg/dl, systolic blood pressure < 90 mmHg | It is a simplified version of the previous one, including the most frequent variables with greater discriminatory power. |
| SMART-COP | Respiratory rate ≥ 30 per minute, PaO2/FiO2 ratio < 250, multilobular infiltrate, confusion or disorientation, urea ≥ 50 mg/dl, systolic blood pressure < 90 mmHg | Similar to the minor criteria of the IDSA/ATS, however, the scoring system weighs more variables with greater discriminatory power. The calculation is more complex than the IDSA/ATS criteria. |
| CURB-65 | Mental confusion; uremia; respiratory rate ≥ 30 per minute; systolic blood pressure < 90 mmHg or diastolic blood pressure ≤ 60 mmHg; age ≥ 65 years. | It is the simplest and best mortality predictor. It can predict admission to the ICU and should not be used for this purpose. |
| PSI | Multiple components, including age, gender, comorbidities, physical examination, laboratory, and radiological findings. | Excellent 30-day mortality predictor. It can predict ICU admission and should not be used for this purpose. |
| SCAP | Arterial pH <7.3, systolic blood pressure < 90 mmHg, Respiratory rate ≥ 30 mRPM, altered mental status, urea ≥ 50 mg/dl, PaO2 < 54 mmHg or PaO2/FiO2 ratio < 250, age ≥ 80 years, bilateral or multilobar lung consolidation. | Variables are similar to those of IDSA/ATS and SMART-COP. |
5 grams per deciliter; age-adjusted respiratory rate; tachycardia less than or equal to 125; confusion; age-adjusted oxygenation; pH less than 7.35.ICU, intensive care unit. IDSA/ATS, Infectious Diseases Society of America/American Thoracic Society. PSI, Pneumonia Severity Index. PaO2/FiO2 ratio, arterial oxygen partial pressure ratio to fractional inspired oxygen. SCAP, Severe Community-Acquired Pneumonia. SMART-COP, systolic blood pressure less than 90 millimeters of mercury; multilobar involvement; albumin less than 3. mmHg, millimeters of mercury..
Source: Prepared by the authors