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Acil serviste toplum kökenli pnömoni tanısı alan hastalarda PSI ve CURB-65 pnömoni skorlama sistemlerinin değerlendirilmesi

Yıl 2017, , 586 - 596, 19.09.2017

Güzin İlhan Zeynep Karakaya Pınar Yaşim Akyol , Fatih Esad Topal Umut Payza

https://doi.org/10.7197/223.v39i31705.347458

Öz

Amaç: Bu çalışmadaki amacımız, hastanemiz acil servisine başvuran toplum kökenli pnömoni tanılı
hastalarda, pnömoni ciddiyet indeksi (PSI) ve CURB-65 pnömoni skorlama
sistemlerinin hastaneye yatış ya da taburculuk açısından uygunluklarının
karşılaştırılmasıdır.



Yöntem: Bu
retrospektif çalışmaya Haziran 2013-Haziran 2014 tarihleri arasında acil servise başvuran ve pnömoni tanısı alan 150 olgu dahil edildi. Olguların demografik özellikleri, klinik, radyolojik ve laboratuar bulguları
kayıt edildi. Tüm olgular PSI ve CURB-65 skorlamasına göre gruplandırıldı ve
hastaneye yatış ya da taburculuk açısından uygunlukları incelendi.



Bulgular: Çalışmaya yaş ortalamaları 69.15 ± 13.34 (min: 19; max:
92) olan 47 (%31.3) kadın, 103 (%68.7) erkek, toplam 150 olgu dahil edildi. Toplam
109 olguda CURB-65 ile PSI arasında yatarak tedavi gerekliliği açısından
uyumluluk mevcuttu (κ=0,602, p<0,001).
Yoğun bakım yatış olasılığı ele alındığında, PSI, CURB-65’e göre
daha anlamlı bulundu (p=0,011, p=0,045, p<0, 05).



Sonuç: Güncel
pratikte kullanılmakta olan iki pnömoni ağırlık gruplamasının
(CURB- 65, PSI) hastaneye yatarak tedavi endikasyonunu değerlendirmek
açısından birbirleri ile korele olduğu görüldü. CURB-65, değerlendirme kriterlerinin az olması ve bunların birinci
basamak merkezlerde dahi kolaylıkla uygulanabilecek kriterler olması nedeni ile
pnömoni olgularında yatarak tedavi gerekliliğini değerlendirmede
tercih edilecek yöntem olabilir. 

Anahtar Kelimeler

Toplum Kökenli Pnömoni PSI CURB-65 Acil Servis

Kaynakça

  • 1. Özlü T, Bülbül Y, Alatas F, Arseven O, Coşkun A Ş, Çilli A, Ekim N , Erdem H , Gürsel G, Hatipoğlu N, Leblebicioğlu H, Mülazımoğlu L, Özden H, Özinel M A, Şahinöz S, Tabakoğlu E, Uçku R, Ünal S Türk Toraks Dernegi Eriskinlerde Toplumda Gelisen Pnömoni Tanı ve Tedavi Uzlası Raporu. Türk Toraks Dergisi 2009; 10: 3-16.
  • 2. Shah BA, Ahmed W, Dhobi NG, Shah NN, Khursheed SQ, Haq I. Validity of pneumoni severity index and CURB-65 severity scoring systems in community acquired pneumonia in an Indian Setting. The Indian Journal of Chest Diseases and Allied Sciences 2010; 52: 9-17.
  • 3. Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, Coley CM, Marrie TJ, Kapoor WN.A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med 1997; 336: 243-50.
  • 4. Ozol D, Bacakoglu F, Oktem S, Cirit M, Ozhan M. Ciddi Toplum Kokenli Pnomonilerin Prognozunda Klinik Parametrelerin Rolu. Ege Universitesi Tıp Fakültesi, Gogus Hastalıkları Anabilim Dalı, Izmir. Toraks Dergisi, 2000; 1: 8-13.
  • 5. Fidan A, Kıral N, Erdem D, Eren A, Sarac G, Caglayan B. Toplum kokenli pnomonilerde hastane mortalitesi ve ulusal pnomoni tanı ve tedavi rehberlerine gore degerlendirme. Toraks Derg 2005; 6: 115-21.
  • 6. Lim WS, van der Eerden MM, Laing R, Boersma WG, Karalus N Town GI, Lewis SA, Macfarlane JT. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 2003; 58: 377-82.
  • 7. Huxley E, Viroslav J, Gray W. Pharyngeal aspiration in normal adults and patients with depressed consciousness. Am J Med 1978; 64: 564-8.
  • 8. Özlü T. Yaslılarda pnömoni. Numanoglu N, Topçu Willke A (editörler). Güncel Bilgiler Isıgında Pnömoniler. Ankara: Bilimsel Tıp Yayınevi, 2000: 332-45.
  • 9. Arseven O. Toplum Kokenli Pnomoniler. Solunum Sistemi Infeksiyonları. Toraks Kitapları. Ekim 201; Sayı 3: 453-48.
  • 10. Lim WS, van der Eerden MM, Laing R, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 2003; 58: 377-82.
  • 11. Raman A, Swinburre AJ, Fedullo AJ. Pneumococcal adherance to the buccal epithelial cells of cigarette smokers. Chest 1983; 83: 23-7.
  • 12. Metlay JP, Schulz R, Li Yi-Hwei, Singer DE, Marrie TJ, Coley CM, Hough LJ, Obrosky DS, Kapoor WN, Fine MJ.Influence of age on symptoms at presentation in patients with community-acquired pneumonia. Arch Intern Med 1997; 157: 1453-9.
  • 13. Luna M. C, Famiglietti A, Absi R, Videla AJ, Nogueira FJ, Fuenzalida AD, Gené RJ.Community acquired pneumonia etiology, epidimiology and outcome at a teaching hospital in Argentina. Chest 2000; 118: 1344-54.
  • 14. Bircan A, Kaya Ö, Gökırmak M, Öztürk Ö, Şahin Ü, Akkaya A, Toplum kökenli pnömonilerin agırlıgının degerlendirilmesinde C-reaktif protein, lökosit sayısı ve eritrosit sedimentasyon hızının yeri Tüberküloz ve Toraks Dergisi 2006; 54: 22-9.
  • 15. Fidan A, Kıral N, Erdem I, Eren A, Saraç G, Çaglayan B. Toplum Kökenli Pnömonilerde Hastane Mortalitesi ve Ulusal Pnömoni Tanı ve Tedavi Rehberine Göre Degerlendirme. Toraks Dergisi 2005; 6-2.
  • 16. Barlett JG, Breiman RF, Mandell LA, File TM Jr. Community acquired pneumonia in adults: Guidelines for managament. Clin Infect Dis. 1998; 26: 811-38.
  • 17. Toplumda Gelisen Pnomonilerin Epidemiyolojisi ve Etiyolojisi. Turkiye Klinikleri J Pulm Med-Special Topics 2011; 4: 1-10.
  • 18. Buising KL, Thursky KA, Black JF, MacGregor L, Street AC, Kennedy MP, Brown GV.A prospective comparison of severity scores for identifying patients with severe community-acquired pneumonia: reconsidering what is meant by severe pneumonia. Thorax 2006; 61: 419-24.
  • 19. Cömert S, Dogan C, Fidan A, Salepçi B, Kıral N, Çaglayan B. Pnömoni agırlık skorlama sistemlerinin hastanede yatarak tedavi endikasyonları açısından karsılastırılması. Turk Toraks Derg 2012; 13: 158-62 .
  • 20. Dean NC, Suchyta MR, Bateman KA, Aronsky D, Hadlock CJ. Implementation of admission decision support for community-acquired pneumonia. Ann Pharmacother 2001; 117: 1368-7.
  • 21. Arnold FW, Brock GN, Peyrani P, Rodrıguez EL, Dıaz AA, Rossi P, Ramirez JA, for the CAPO authors. Predictive accuracy of the pneumonia severity index vs CRB-65 for time to clinical stability: Results from the Community-Acquired Pneumonia Organization (CAPO) International Cohort Study. Respiratory Medicine 2010; 104: 1736-43.
  • 22. Saldias F, Diaz O. Severity scores for predicting clinically relevant outcomes for immunocompetent adult patients hospitalized with community acquired pneumococcal pneumonia. Rev Chil Infect 2011; 28: 303-9.
  • 23. Myınt PK, Kamath AV, Vowler SL, Maısey DN, Harrıson BD. Severity assessment criteria recommended by the British Thoracic Society (BTS) for community-acquired pneumonia and older patients. Should SOAR (systolic blood pressure, oxygenation, age and respiratory rate) criteria be used in older people? A compilation study of two prospective cohorts. Age Ageing 2006; 35: 286-91.
  • 24. Bauer TT, Ewig S, Marre R, Suttorp N, Welte T. CRB-65 predicts death from community-acquired pneumonia. J Intern Med 2006; 260: 93-101.
  • 25. Casado Flores J, Blanco Quiros A. Procalcitonin. A new marker for bacterial infection An Esp Pediatr 2001; 54: 69-73.
  • 26. Chalmers JD, Singanayagam A, Akram AR, Mandal P, Short PM, Choudhury G, Wood V, Hill AT. Severity assessment tools for predicting mortality in hospitalised patients with community- acquired pneumonia. Systematic review and meta-analysis.Thorax 2010; 65: 878-83.
  • 27. Aujesky D, Auble TE, Yealy DM, Stone RA, Obrosky S, Meehan TP, Graff LG, Fine JM, Fine MJ. Prospective comparison of three validated prediction rules for prognosis in community-acquired pneumonia. Am J Med 2005; 118: 384-92.
  • 28. Ozlu T, Metintas M, Karadag M, Kaya A. Solunum Sistemi ve Hastalıkları. Birinci Baskı. Istanbul Tıp Kitabevi 2010, p: 819-52.

Evaulation of PSİ and CURB-65 scoring systems which patients were diagnosed as community-acquired pneumonia in emergency department

Yıl 2017, , 586 - 596, 19.09.2017

Güzin İlhan Zeynep Karakaya Pınar Yaşim Akyol , Fatih Esad Topal Umut Payza

https://doi.org/10.7197/223.v39i31705.347458

Öz

Objective:  
The aim of study is to determine
the correlation between pneumonia severity index (PSI) and CURB-65 according to
the indications for hospitalization or discharge of patients with pneumonia
referred to our emergency department.

Method: This retrospective study was performed on 150 patients with pneumonia
cases admitted to our emergency department between June 2013 and June 2014.
Demographic properties, clinic, radiologic and laboratory findings of cases
were recorded from the files. All cases were grouped according to PSI and
CURB-65 respectively. The correlation of these groups with each other according
to the indications for hospitalization and dischargement was examined.

Results: 47 (31.3%)
female, 103 (68.7%) male 150 pneumonia cases aged 69.15±13.34 (min: 19; max: 92) years were
included in the study. CURB-65 and PSI correlated in terms of hospitalization
in 109 cases. CURB-65 and PSI were statistically correlated with each other (κ=0,602,
p<0,001) .We found that, determining the
probability of intensive care unit indication, PSI more significant than
CURB-65 (p=0,011,
p=0,045, p<0,05).







Conclusions:  It is seen that currently used two pneumonia severity classifications
(CURB-65, PSI) were correlated with each other according to the assessment of
the indications for hospitalization. Since the scoring criteria of CURB-65 is
fewer and easy to application even at the first line medical centers, of these
pneumonia scoring systems it can be the first choice in the assessment of need
of hospitalization indication in pneumonia.

Anahtar Kelimeler

Community-acquired pneumonia PSI CURB-65 Emergency Department

Kaynakça

  • 1. Özlü T, Bülbül Y, Alatas F, Arseven O, Coşkun A Ş, Çilli A, Ekim N , Erdem H , Gürsel G, Hatipoğlu N, Leblebicioğlu H, Mülazımoğlu L, Özden H, Özinel M A, Şahinöz S, Tabakoğlu E, Uçku R, Ünal S Türk Toraks Dernegi Eriskinlerde Toplumda Gelisen Pnömoni Tanı ve Tedavi Uzlası Raporu. Türk Toraks Dergisi 2009; 10: 3-16.
  • 2. Shah BA, Ahmed W, Dhobi NG, Shah NN, Khursheed SQ, Haq I. Validity of pneumoni severity index and CURB-65 severity scoring systems in community acquired pneumonia in an Indian Setting. The Indian Journal of Chest Diseases and Allied Sciences 2010; 52: 9-17.
  • 3. Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, Coley CM, Marrie TJ, Kapoor WN.A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med 1997; 336: 243-50.
  • 4. Ozol D, Bacakoglu F, Oktem S, Cirit M, Ozhan M. Ciddi Toplum Kokenli Pnomonilerin Prognozunda Klinik Parametrelerin Rolu. Ege Universitesi Tıp Fakültesi, Gogus Hastalıkları Anabilim Dalı, Izmir. Toraks Dergisi, 2000; 1: 8-13.
  • 5. Fidan A, Kıral N, Erdem D, Eren A, Sarac G, Caglayan B. Toplum kokenli pnomonilerde hastane mortalitesi ve ulusal pnomoni tanı ve tedavi rehberlerine gore degerlendirme. Toraks Derg 2005; 6: 115-21.
  • 6. Lim WS, van der Eerden MM, Laing R, Boersma WG, Karalus N Town GI, Lewis SA, Macfarlane JT. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 2003; 58: 377-82.
  • 7. Huxley E, Viroslav J, Gray W. Pharyngeal aspiration in normal adults and patients with depressed consciousness. Am J Med 1978; 64: 564-8.
  • 8. Özlü T. Yaslılarda pnömoni. Numanoglu N, Topçu Willke A (editörler). Güncel Bilgiler Isıgında Pnömoniler. Ankara: Bilimsel Tıp Yayınevi, 2000: 332-45.
  • 9. Arseven O. Toplum Kokenli Pnomoniler. Solunum Sistemi Infeksiyonları. Toraks Kitapları. Ekim 201; Sayı 3: 453-48.
  • 10. Lim WS, van der Eerden MM, Laing R, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 2003; 58: 377-82.
  • 11. Raman A, Swinburre AJ, Fedullo AJ. Pneumococcal adherance to the buccal epithelial cells of cigarette smokers. Chest 1983; 83: 23-7.
  • 12. Metlay JP, Schulz R, Li Yi-Hwei, Singer DE, Marrie TJ, Coley CM, Hough LJ, Obrosky DS, Kapoor WN, Fine MJ.Influence of age on symptoms at presentation in patients with community-acquired pneumonia. Arch Intern Med 1997; 157: 1453-9.
  • 13. Luna M. C, Famiglietti A, Absi R, Videla AJ, Nogueira FJ, Fuenzalida AD, Gené RJ.Community acquired pneumonia etiology, epidimiology and outcome at a teaching hospital in Argentina. Chest 2000; 118: 1344-54.
  • 14. Bircan A, Kaya Ö, Gökırmak M, Öztürk Ö, Şahin Ü, Akkaya A, Toplum kökenli pnömonilerin agırlıgının degerlendirilmesinde C-reaktif protein, lökosit sayısı ve eritrosit sedimentasyon hızının yeri Tüberküloz ve Toraks Dergisi 2006; 54: 22-9.
  • 15. Fidan A, Kıral N, Erdem I, Eren A, Saraç G, Çaglayan B. Toplum Kökenli Pnömonilerde Hastane Mortalitesi ve Ulusal Pnömoni Tanı ve Tedavi Rehberine Göre Degerlendirme. Toraks Dergisi 2005; 6-2.
  • 16. Barlett JG, Breiman RF, Mandell LA, File TM Jr. Community acquired pneumonia in adults: Guidelines for managament. Clin Infect Dis. 1998; 26: 811-38.
  • 17. Toplumda Gelisen Pnomonilerin Epidemiyolojisi ve Etiyolojisi. Turkiye Klinikleri J Pulm Med-Special Topics 2011; 4: 1-10.
  • 18. Buising KL, Thursky KA, Black JF, MacGregor L, Street AC, Kennedy MP, Brown GV.A prospective comparison of severity scores for identifying patients with severe community-acquired pneumonia: reconsidering what is meant by severe pneumonia. Thorax 2006; 61: 419-24.
  • 19. Cömert S, Dogan C, Fidan A, Salepçi B, Kıral N, Çaglayan B. Pnömoni agırlık skorlama sistemlerinin hastanede yatarak tedavi endikasyonları açısından karsılastırılması. Turk Toraks Derg 2012; 13: 158-62 .
  • 20. Dean NC, Suchyta MR, Bateman KA, Aronsky D, Hadlock CJ. Implementation of admission decision support for community-acquired pneumonia. Ann Pharmacother 2001; 117: 1368-7.
  • 21. Arnold FW, Brock GN, Peyrani P, Rodrıguez EL, Dıaz AA, Rossi P, Ramirez JA, for the CAPO authors. Predictive accuracy of the pneumonia severity index vs CRB-65 for time to clinical stability: Results from the Community-Acquired Pneumonia Organization (CAPO) International Cohort Study. Respiratory Medicine 2010; 104: 1736-43.
  • 22. Saldias F, Diaz O. Severity scores for predicting clinically relevant outcomes for immunocompetent adult patients hospitalized with community acquired pneumococcal pneumonia. Rev Chil Infect 2011; 28: 303-9.
  • 23. Myınt PK, Kamath AV, Vowler SL, Maısey DN, Harrıson BD. Severity assessment criteria recommended by the British Thoracic Society (BTS) for community-acquired pneumonia and older patients. Should SOAR (systolic blood pressure, oxygenation, age and respiratory rate) criteria be used in older people? A compilation study of two prospective cohorts. Age Ageing 2006; 35: 286-91.
  • 24. Bauer TT, Ewig S, Marre R, Suttorp N, Welte T. CRB-65 predicts death from community-acquired pneumonia. J Intern Med 2006; 260: 93-101.
  • 25. Casado Flores J, Blanco Quiros A. Procalcitonin. A new marker for bacterial infection An Esp Pediatr 2001; 54: 69-73.
  • 26. Chalmers JD, Singanayagam A, Akram AR, Mandal P, Short PM, Choudhury G, Wood V, Hill AT. Severity assessment tools for predicting mortality in hospitalised patients with community- acquired pneumonia. Systematic review and meta-analysis.Thorax 2010; 65: 878-83.
  • 27. Aujesky D, Auble TE, Yealy DM, Stone RA, Obrosky S, Meehan TP, Graff LG, Fine JM, Fine MJ. Prospective comparison of three validated prediction rules for prognosis in community-acquired pneumonia. Am J Med 2005; 118: 384-92.
  • 28. Ozlu T, Metintas M, Karadag M, Kaya A. Solunum Sistemi ve Hastalıkları. Birinci Baskı. Istanbul Tıp Kitabevi 2010, p: 819-52.
Toplam 28 adet kaynakça vardır.

Ayrıntılar

Konular Sağlık Kurumları Yönetimi
Bölüm Medical Science Research Makaleler
Yazarlar

Güzin İlhan

Zeynep Karakaya

Pınar Yaşim Akyol

Fatih Esad Topal

Umut Payza

Yayımlanma Tarihi 19 Eylül 2017
Kabul Tarihi 29 Ağustos 2017
Yayımlandığı Sayı Yıl 2017

Kaynak Göster

AMA İlhan G, Karakaya Z, Akyol PY, Topal FE, Payza U. Evaulation of PSİ and CURB-65 scoring systems which patients were diagnosed as community-acquired pneumonia in emergency department. CMJ. Eylül 2017;39(3):586-596. doi:10.7197/223.v39i31705.347458