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Sepsis severity predicts outcome in community-acquired pneumococcal pneumonia

¹ Medical Clinic III, and ² Institute of Microbiology, University of Lübeck, Lübeck, ³ Institute of Microbiology, National Reference Centre for Streptococci, University Hospital (RWTH), Aachen, ⁴ Medical Clinic, Research Centre Borstel, Borstel, and ⁵ Thoraxzentrum Ruhrgebiet, Dept of Respiratory Medicine and Infectious Diseases, Bochum, Germany.

CORRESPONDENCE: B. Schaaf, Medical Clinic III, University of Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany. Fax: 49 4515006014. E-mail: schaaf{at}uni-luebeck.de

Keywords: Antibiotic treatment, pneumococcal infection, pneumonia, risk classification, sepsis

Received: February 20, 2007
Accepted May 14, 2007

Easily performed prognostic rules are helpful for guiding the intensity of monitoring and treatment of patients. The aim of the present study was to compare the predictive value of the sepsis score and the Confusion, Respiratory rate (30 breaths·min^–1), Blood pressure (systolic value <90 mmHg or diastolic value 60 mmHg) and age 65 yrs (CRB-65) score in 105 patients with community-acquired pneumococcal pneumonia. In addition, the influence of timing of the antimicrobial treatment on outcome was investigated. The sepsis and the CRB-65 scores were used to allocate patients to subgroups with low, intermediate and high risk.

Comparable, highly predictive values for mortality were found for both scores (sepsis score versus CRB-65): 1) low-risk group, 0 versus 0%; 2) intermediate-risk group, 0 versus 8.6%; 3) high-risk group, 30.6 versus 40%, with an area under the curve of 0.867 versus 0.845. Patients with ambulatory antibiotic pre-treatment had less severe disease with a lower acute physiology score, lower white blood cell count and a faster decline of C-reactive protein levels. No pre-treated patient died.

In summary, both scores performed equally well in predicting mortality. The prediction of survival in the intermediate-risk group might be more accurate with the sepsis score. Pre-hospital antibiotic treatment was associated with less severe disease.

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