DÄ internationalArchive9/2018Adequate Risk Stratification

Correspondence

Adequate Risk Stratification

Dtsch Arztebl Int 2018; 115: 145. DOI: 10.3238/arztebl.2018.0145a

Evangelatos, N; Gerlach, T

LNSLNS

Community-acquired pneumonia is one of the main causes of hospital admission, morbidity, and mortality. The case fatality rate of patients who require ICU admission in multicenter cohort studies is more than 40%. The disease course of pneumosepsis is associated with complications and represents a medical emergency, which has to be identified and treated in a timely manner (1).

In clinical practice, diverse scoring models are often used in order to assess patients with regard to the severity of their illness. These models entail various problems, however, which limit their validity. For community-acquired pneumonia (CAP) and CAP-associated sepsis, it is of particular relevance that using different scores can result in different clinical decisions.

The following example illustrates the problem around conventional clinical assessment tools. In a 60-year-old patient with CAP, a respiratory rate of 26 breaths/minute, blood pressure of 95/65 mmHG, blood-urea-nitrogen (BUN) of 18 mg/dL, and a normal mental state, the estimated mortality according to the validated prognostic CURB65 score (developed for pneumonia) is 0.6%, and the patient could therefore receive outpatient treatment. When the qSOFA score (the new scoring tool for patients with suspected sepsis) is applied, however, this patient has likely developed sepsis and should be treated in the intensive care unit (2, 3).

This example demonstrates that clinicians need to consider additional parameters to merely applying scoring models. The new omics technologies are likely to enrich our armamentarium in the fight against diseases and enable rapid diagnosis and treatment.

DOI: 10.3238/arztebl.2018.0145a

Dr. med. Nikolaos Evangelatos

Medizinische Klinik 3, Internistische Intensivstation, Klinikum Nürnberg

Nikolaos.Evangelatos@klinikum-nuernberg.de

Dr. med. Thomas Gerlach

Medizinische Klinik 6, Zentrale Notaufnahme, Klinikum Nürnberg

Thomas.Gerlach@klinikum-nuernberg.de

Conflict of interest statement

The authors declare that no conflict of interest exists.

1.
Phua J, Dean NC, Guo Q, Kuan WS, Lim HF, Lim TK: Severe community-acquired pneumonia: timely management measures in the first 24 hours. Crit Care 2016; 20: 237 CrossRef MEDLINE PubMed Central
2.
Josh Farkas: PulmCrit—top ten problems with the new sepsis definition. www.emcrit.org/pulmcrit/problems-sepsis-3-definition/ (last accessed on 26 February 2017).
3.
Singer M, Deutschman CS, Seymour CW, et al.: The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 2016; 315: 801–10 CrossRef MEDLINE PubMed Central
4.
Kolditz M, Ewig S: Community-acquired pneumonia in adults. Dtsch Arztebl Int 2017; 114: 838–48 VOLLTEXT
1.Phua J, Dean NC, Guo Q, Kuan WS, Lim HF, Lim TK: Severe community-acquired pneumonia: timely management measures in the first 24 hours. Crit Care 2016; 20: 237 CrossRef MEDLINE PubMed Central
2.Josh Farkas: PulmCrit—top ten problems with the new sepsis definition. www.emcrit.org/pulmcrit/problems-sepsis-3-definition/ (last accessed on 26 February 2017).
3.Singer M, Deutschman CS, Seymour CW, et al.: The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 2016; 315: 801–10 CrossRef MEDLINE PubMed Central
4.Kolditz M, Ewig S: Community-acquired pneumonia in adults. Dtsch Arztebl Int 2017; 114: 838–48 VOLLTEXT

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