Lactate vs CURB 65 and CRB65 as a predictor of clinical outcomes in community-acquired pneumonia

Lactato vs CURB 65 y CRB65 como predictor de resultados clínicos en neumonía adquirida en la comunidad

Introduction: community-acquired pneumonia (CAP) is the leading cause of death from an infectious disease worldwide and in Colombia, hence scales or measures for prognosis prediction are essential for defining its management. Objectives: to evaluate whether lactate and CURB65 and CRB65 severity scores are related to clinical outcomes in hospitalized patients admitted with CAP. Materials and methods: a retrospective study including patients admitted to the emergency room for CAP in two university hospitals in Bogotá. The sensibility, specificity, predictive values, and areas under the curve (AUC) of lactate, CRB65, and CURB65, were established to identify in-hospital mortality, need of intensive care unit (ICU) admission and mechanical ventilation (MV). Results: 153 patients were included, 78 (51%) were men and the median age was 75 years (IQR 62 - 83). The AUC to identify in-hospital mortality was 0.76 (CI 95%=0.65-0.87) for CURB65, and 0.70 (CI 95%=0.56-0.83) for lactate. Regarding patients requiring ICU admission, CURB65 had an AUC=0.77 (IC 95%=0.69-0.86) and lactate an AUC=0.67 (IC 95%= 0.54-0.80). Combining lactate and CURB65 did not improve the AUCs for the evaluated outcomes. Conclusion: in the study population, CURB-65 better predicted clinical outcomes in patients hospitalized for CAP. Adding lactate did not improve prognosis assessment.

1. World Health Organization. Global health estimates 2016: disease burden by cause, age, sex, by country and by region, 2000–2016. Geneva: World Health Organization; 2018.
2. World Health Organization. Disease burden and mortality estimates 2000–2016 [Internet]. Geneva; 2018 [citado 24 June 2019]. Disponible en: https://www.who.int/healthinfo/global_burden_disease/estimates/en/index1.html.
3. Aliberti S, Dela Cruz CS, Amati F, Sotgiu G, Restrepo MI. Community-acquired pneumonia. Lancet. 2021;398(10303):906-919. https://doi.org/10.1016/S0140-6736(21)00630-9.
4. Lopardo GD, Fridman D, Raimondo E, Albornoz H, Lopardo A, Bagnulo H, et al. Incidence rate of community-acquired pneumonia in adults: a population-based prospective active surveillance study in three cities in South America. BMJ Open. 2018;8(4):e019439. https://doi.org/10.1136/bmjopen-2017-019439.
5. Torres A, Chalmers JD, Dela Cruz CS, Dominedò C, Kollef M, Martin-Loeches I, Niederman M, Wunderink RG. Challenges in severe community-acquired pneumonia: a point-of-view review. Intensive Care Med. 2019;45(2):159-171. https://doi.org/10.1007/s00134-019-05519-y.
6. Rider AC, Frazee BW. Community-Acquired Pneumonia. Emerg Med Clin North Am. 2018;36(4):665-683 https://doi.org/10.1016/j.emc.2018.07.001.
7. Martínez-Vernaza S, Mckinley E, Soto MJ, Gualtero S. Neumonía adquirida en la comunidad: una revisión narrativa. Univ Med. 2018;59(4):1-10. https://doi.org/10.11144/Javeriana.umed59-4.neum.
8. Cortés JA, Cuervo-Maldonado SI, Nocua-Báez LC, Valderrama MC, Sánchez EA, Saavedra A, et al. [Guía de práctica clínica para el manejo de la neumonía adquirida en la comunidad]. Rev. Fac. Med. 2022;70(2):e93814. https://doi.org/10.15446/revfacmed.v70n2.93814.
9. Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997;336(4):243-50. https://doi.org/10.1056/NEJM199701233360402.
10. Lim WS, van der Eerden MM, Laing R, Boersma WG, Karalus N, Town GI, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 2003;58(5):377-82. https://doi.org/10.1136/thorax.58.5.377.
11. Metlay JP, Waterer GW, Long AC, Anzueto A, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45–e67. https://doi.org/10.1164/rccm.201908-1581ST.
12. Ning P, Zheng Y, Luo Q, Liu X, Kang Y, Zhang Y, et al. Metabolic profiles in community-acquired pneumonia: developing assessment tools for disease severity. Crit Care. 2018;22(1):130. https://doi.org/10.1186/s13054-018-2049-2.
13. Frenzen FS, Kutschan U, Meiswinkel N, Schulte-Hubbert B, Ewig S, Kolditz M. Admission lactate predicts poor prognosis independently of the CRB/CURB-65 scores in community-acquired pneumonia. Clin Microbiol Infect. 2018;24(3):306.e1-306.e6. https://doi.org/10.1016/j.cmi.2017.07.007.
14. Chen YX, Li CS. Lactate on emergency department arrival as a predictor of mortality and site-of-care in pneumonia patients: a cohort study. Thorax. 2015;70(5):404-410. https://doi.org/10.1136/thoraxjnl-2014-206461.
15. Demirel B. Lactate levels and pneumonia severity index are good predictors of in-hospital mortality in pneumonia. Clin Respir J. 2018;12(3):991-995. https://doi.org/10.1111/crj.12616.
16. Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021;47(11):1181-1247. https://doi.org/10.1007/s00134-021-06506-y.
17. Zhang ZX, Yong Y, Tan WC, Shen L, Ng HS, Fong KY. Prognostic factors for mortality due to pneumonia among adults from different age groups in Singapore and mortality predictions based on PSI and CURB-65. Singapore Med J. 2018;59(4):190-198. https://doi.org/10.11622/smedj.2017079.