Utility of the Quick Sequential Organ Failure Assessment in Japanese patients with nursing- and healthcare-associated pneumonia

Shingo Noguchi; Kazuhiro Yatera; Keisuke Naito; Ryosuke Hata; Toshinori Kawanami; Kei Yamasaki; Tatsuji Kato; Takeshi Orihashi; Naoyuki Inoue; Noriho Sakamoto; Chiharu Yoshii; Hiroshi Mukae

doi:10.1111/ggi.13581

Utility of the Quick Sequential Organ Failure Assessment in Japanese patients with nursing- and healthcare-associated pneumonia

Geriatr Gerontol Int. 2019 Mar;19(3):177-183. doi: 10.1111/ggi.13581. Epub 2018 Dec 16.

Authors

Affiliations

¹ Department of Respiratory Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
² Department of Respiratory Medicine, Tobata Kyoritsu Hospital, Kitakyushu, Japan.
³ Department of Respiratory Medicine, Kitakyushu General Hospital, Kitakyushu, Japan.
⁴ Department of Internal Medicine, Kyushu Rosai Hospital, Kitakyushu, Japan.
⁵ Department of Respiratory Medicine, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
⁶ Department of Respiratory Medicine, Wakamatsu Hospital of the University of Occupational and Environmental Health, Kitakyushu, Japan.

PMID: 30556241
DOI: 10.1111/ggi.13581

Abstract

Aim: To clarify the utility of sepsis evaluation using the Quick Sequential Organ Failure Assessment (qSOFA) tool in addition to the Pneumonia Severity Index (PSI); age, dehydration, respiration, orientation and blood pressure (A-DROP) index; and immunodeficiency, respiration, orientation, age and dehydration (I-ROAD) scoring systems, and risk factor evaluation of potentially drug-resistant (PDR) pathogens are suggested in the 2017 guidelines for pneumonia of the Japanese Respiratory Society in nursing- and healthcare-associated pneumonia patients.

Methods: We included 289 hospitalized nursing- and healthcare-associated pneumonia patients between April 2016 and March 2017, and investigated the ability of PSI, A-DROP, I-ROAD and qSOFA to predict pneumonia-related mortality. We also evaluated the associations among the risk factors for PDR pathogens, the detection ratio of PDR pathogens and pneumonia-related mortality.

Results: The mortality rate of pneumonia during hospitalization was 6.9% (20/289). The area under the curve for pneumonia-related mortality predicted using PSI, A-DROP, I-ROAD and qSOFA was 0.697 (95% confidence interval [CI] 0.59-0.80), 0.63 (95% CI 0.51-0.76), 0.61 (95% CI 0.52-0.70) and 0.701 (95% CI 0.59-0.81), respectively. In addition, higher areas under the curve were observed for pneumonia-related mortality predicted according to a combination of PSI and hypoalbuminemia (<2.5 g/dL) (0.75, 95% CI 0.64-0.86), and qSOFA and hypoalbuminemia (0.74, 95% CI 0.62-0.86) than for PSI and qSOFA alone. No significant associations were observed among the risk factors for PDR pathogens, the detection ratios of PDR pathogens and pneumonia-related mortality.

Conclusions: qSOFA and the combination of qSOFA and hypoalbuminemia might be simple and useful evaluation tools for predicting pneumonia-related mortality in nursing- and healthcare-associated pneumonia patients. Geriatr Gerontol Int 2019; 19: 177-183.

Keywords: Pneumonia Severity Index; Quick Sequential Organ Failure Assessment; age; blood pressure and immunodeficiency; dehydration; orientation; pneumonia-related mortality; respiration.

MeSH terms

Aged
Aged, 80 and over
Female
Geriatric Assessment
Health Status Indicators*
Healthcare-Associated Pneumonia / complications
Healthcare-Associated Pneumonia / diagnosis*
Healthcare-Associated Pneumonia / mortality*
Hospital Mortality
Humans
Japan
Male
Predictive Value of Tests
Retrospective Studies
Risk Factors
Sepsis / complications
Sepsis / diagnosis*
Sepsis / mortality*