Pneumonia severity scores have been used to predict 30-day mortality in patients presenting with CAP, the authors explain, but their utility to predict the development of complicated parapneumonic effusion or empyema has not been studied.
Dr. James D. Chalmers and colleagues from the Royal Infirmary of Edinburgh in Scotland set out to identify key factors predicting the development of these complications in patients admitted with CAP.
They report that recognized severity scores poorly predicted complicated parapneumonic effusion and empyema in these patients.
However, seven clinical factors emerged as independent risk factors for these complications on multivariate logistic regression, including serum albumin below 30 g/L, C-reactive protein above 100 mg/L, platelet count above 400 billion/L, sodium below 130 mmol/L, intravenous drug use, and chronic alcohol abuse. A history of chronic obstructive pulmonary disease (COPD) was associated with a lower risk.
When each risk factor was given a value of 1 (except the history of COPD, which was given a value of negative 1), a cutoff of 2 or more points accurately separated patients with a high and low risk of developing complicated parapneumonic effusion and empyema, the investigators say.
The 2-point cut-off was 87.0% sensitive and 68.3% specific and gave a positive predictive value of 17.7% and a negative predictive value of 98.5%. This score was superior to all pneumonia severity scores in predicting complicated parapneumonic effusion or empyema.
"This study," the investigators say, "has provided proof of the concept that complicated parapneumonic effusion and empyema can be predicted by deriving a scoring system with good predictive value."
"Independent validation studies are needed," they add.
"Exactly which biomarker is most appropriate and what cut-off levels should be used to affect the management decisions requires further clarification," writes Dr. Jeremy S. Brown from University College Medical School, London, UK, in a related editorial.
"Furthermore," Dr. Brown concludes, "any changes to CAP guidelines to include the use of biomarkers along the lines described above would ideally need support from prospective trials."
Thorax 2009;64:556-558,592-597.
Source : http://www.medscape.com/viewarticle/706328?sssdmh=dm1.503531&src=nldne
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