Retrospective analysis of hospitalized community acquired pneumonia patients in regards to their management, treatment and prognosis

Community Acquired Pneumonia (CAP) is a very common and serious health issue across the World. Severity scores that evaluate the severity of pneumonia and guidelines were developed for diagnosis and treatment in adults. Pneumonia severity index scores are useful in guiding the decisions regarding patients' admission, treatment and place of treatment as well as predicting the lenght of hospitalization, prognosis, mortality and recurrence. In this research it was aimed to evaluate the pneumonia severity indexes PSI, CURB-65, expanded CURB-65 (eCURB-65), A-DROP, SOFA, Glasgow Prognostic Score (GPS), Severe Community Acquired Pneumonia (SCAP), SMART-COP, and Mixed Inflammatory Index-1 (MII-1) indexes and their places in diagnosis and treatment respectively. We included in our research 155 CAP cases that were diagnosed according to Turkish Thoracic Society Consensus report for CAP diagnosis and Treatment. Bloodwork results including biochemical markers, complete blood count, arterial blood gas, infectious markers, radiological findings, lenght of hospital stay, treatments received, wards where treatment were received, status of discharge were recorded retrospectively. Pneumonia severity scores and indexes were calculated for each case. The patients included in this research were 87 male (%56) and 68 female (%44). Mean age of the patients was 71±15 yıl (21-98). Most common comorbidity recorded was hypertension (n:97, %62), followed by diabetus mellitus (n:59, %38), coronary artery disease (n:59, %38) and COPD (n:58, %38). Patients from group 2 according to TTS guidelines were admitted to the ward most commonly. Mean lenght for hospital stay was 8±5 days.There were 10 cases that needed ICU transfer and 26 cases that needed NIMV support. For 21 cases recurrence of disease occurred within 3 months of discharge. There was not stastistically significant effect of radiological infiltration patterns of pneumonia, microbiological pathogens isolated or antibiotic treatment on prognosis of patients. It was found that the indexes we used for this research were corelated for predicting pnumonia severity and determined the severity of pneumonia in a similar manner. Patients who stayed in the hospital had significantly less prone to mortality (p=0,02) whereas LDH values (p=0,001) and PAI (p=0,002), CURB-65 (p=0,049), SCAP (p=0,008), and SMART-COP (p=0,02) scores were significantly higher in patients who dies. The extent of patients' stay in the hospital (p=0,01), MII-1(p=0,006) and A-DROP (p=0,04) were significantly lower in patients that suffered recurrence of disease. When the best prognostic test to predict the need for NIMV was researched we found SMART-COP (AUC=0,80; p<0,001) to be the best. For predicting need for ICU transfer and mortality PSI (AUC=0,77; p<0,001) was the best. For predicting recurrence MII-1 (AUC=0,7; p=0,02) was the best prognostic score amongst all. In conclusion pneumonia severity indexes are remarkably sensitive indexes that are utilized to determine the severity and place of treatment for pneumonia patients. In this research in order to determine the risks of need for NIMV support, mortality, ICU admission and recurrence; SMART-COP, PSI and MII-1 have been found to be the most useful ones respectively.