Prognosis predictability of combination between lactate and SMART-COP in elderly hospitalized patients with community-acquired pneumonia in the emergency department

Jeong, Ah Young; Oh, Sanghee; Park, Sanghyun; Youn, Chun Song; Park, Jung Ho; Choi, Seung Pill; Oh, Jae Hun; Park, In A

J Korean Soc Emerg Med > Volume 31(2); 2020 > Article

Original Article

Journal of The Korean Society of Emergency Medicine 2020;31(2): 200-209.

응급실에 입원한 지역사회획득 폐렴 노인환자에서 lactate와 SMART-COP조합의 예후 예측 능력

정아영¹

¹가톨릭대학교 여의도성모병원 응급의학과
²가톨릭대학교 서울성모병원 응급의학과
³가톨릭대학교 은평성모병원 응급의학과

Prognosis predictability of combination between lactate and SMART-COP in elderly hospitalized patients with community-acquired pneumonia in the emergency department

¹Department of Emergency Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
²Department of Emergency Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
³Department of Emergency Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

Correspondence

Sanghee Oh ,Tel: 02-3779-1817, Fax: 02-780-9114, Email: osh0532@hanmail.net,

Received: July 4, 2010; Revised: October 11, 2019 Accepted: October 28, 2019. Published online: April 30, 2020.

ABSTRACT

Objective:
Community-acquired pneumonia (CAP) in older patients is a potentially life-threatening infection with a poor prognosis. Therefore, is important to predict the mortality rate of CAP for older patients. This study examined the effects of predictive increases on CAP mortality by adding a biomarker to known CAP severity prediction tools.
Method:
A retrospective analysis of information was conducted on patients older than 65 years, who were treated with CAP in five emergency departments from October 2016 to February 2017. The primary outcome was the 28-day mortality. The following were calculated for each patient: qSOFA (quick Sequential Organ Failure Assessment), A-DROP (Age, Dehydration, Respiratory failure, Orientation, blood Pressure), CURB-65 (Confusion, Urea level, Respiratory rate, Blood pressure, age≥65 years), SMART-COP (Systolic blood pressure, Multilobar infiltrates, Albumin, Respiratory rate, Tachycardia, Confusion, Oxygen and pH), NLR (neutrophil:lymphocyte ratio), PLR (platelet:lymphocyte ratio), and CAR (high-sensitivity C-reactive protein:albumin ratio). The prognostic value for the 28-day mortality was determined by multivariate logistic regression analysis.
Results:
The 28-day mortality was 12.0% of 693 CAP patients. Multivariate logistic regression analysis showed that lactate (odds ratio [OR], 1.589; P<0.001) and CAR (OR, 1.208; P=0.006) were correlated with the 28-day mortality. NLR (OR, 1.00; P=0.983) and PLR (OR, 1.00; P=0.784) were not correlated. The area under curve (AUC) was significant as CAR 0.649, lactate 0.737, and SMART-COP 0.735 (P<0.001), and the AUC of lactate+SMART-COP increased significantly to 0.784 compared to SMART-COP (P=0.014).
Conclusion:
A combination of lactate and SMART-COP can be used as a tool to assess the severity of older hospitalized CAP patients who visited emergency departments.

Key words: Pneumonia; Mortality; Aged; Lactates