PT  - JOURNAL ARTICLE
AU  - Martin Kolditz
AU  - Santiago Ewig
AU  - Gert Höffken
TI  - Management-based risk prediction in community-acquired pneumonia by scores and biomarkers
AID  - 10.1183/09031936.00104412
DP  - 2013 Apr 01
TA  - European Respiratory Journal
PG  - 974--984
VI  - 41
IP  - 4
4099  - http://erj.ersjournals.com/content/41/4/974.short
4100  - http://erj.ersjournals.com/content/41/4/974.full
SO  - Eur Respir J2013 Apr 01; 41
AB  - Community-acquired pneumonia (CAP) represents a major life-threatening infection, but disease course and outcome is highly variable. Major drivers of prognosis are respiratory failure, sepsis-related organ dysfunction and unstable comorbidities. Current risk stratification tools have been primarily designed to predict mortality and identify low risk patients potentially suitable for ambulatory management. Detection of patients at high risk for clinical deterioration by current scores remains suboptimal. Therefore, management-related risk stratification tools designed to predict benefit from early intensified monitoring and treatment strategies in hospitalised CAP are advocated. An approach including early and repeatedly evaluated clinical markers of respiratory failure, sepsis-related organ dysfunction or decompensating comorbidity combined with individual definition of treatment goals is suggested. Inflammatory biomarkers can add prognostic information. New cardiovascular or stress-related biomarkers like copeptin, midregional proadrenomedullin and cortisol have been repeatedly linked with outcome and disease course in CAP and improved clinical scoring in observational studies. Thus they represent promising tools for individualised risk stratification. A major task in future CAP research will be the evaluation of their additional value in large interventional trials with control groups incorporating strict management guidance by clinical criteria.