Article

The risk stratification in community-acquired pneumonia

Correspondence / American Journal of Emergency Medicine 37 (2019) 151172 171

Conflict of interest

The authors declare no competing interests.

Romain Jouffroy, M.D.?

markers, especially for the determination of long-term prognosis in CAP [3]. Elevated levels of Natriuretic peptides and troponins are re- ported to be common and are associated with a higher risk of adverse outcome in CAP. Moreover, decreased right ventricular systolic function

[4] or presence of small pericardial effusion at transhoracic echocardiog-

Anastasia Saade, M.D., Ph.D. Alexandre Muret, M.D. Pascal Philippe, M.D. Maud Michaloux, M.D. Pierre Carli, M.D., Ph.D. Benoit Vivien, M.D., Ph.D.

Intensive Care Unit, Anesthesiology Department and SAMU of Paris, Hopital Necker – Enfants Malades, Assistance Publique – Hopitaux de Paris, Paris

Descartes University, Paris, France

?Corresponding author at: Department of Anesthesia & Intensive Care Unit, SAMU, Hopital Necker Enfants Malades, University Paris Descartes,

149 rue de Sevres, 75015 Paris, France.

E-mail address: [email protected] (R. Jouffroy).

24 May 2018

https://doi.org/10.1016/j.ajem.2018.05.057

References

  1. Zhou X, et al. Fluid resuscitation in pre-hospital patients with septic shock: one size does not fit all. Journal title 2018:AJEM18056.
  2. Jouffroy R, Saade A, Muret A, Philippe P, Michaloux M, Carli P, et al. Fluid resuscitation in pre-hospital management of septic shock. Am J Emerg Med 2018 Oct;36(10):1754-8.
  3. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving sep- sis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med 2013;41(2):580-637.
  4. Martin C, Brun-Buisson C. Initial management of severe sepsis in adults and children. Ann Fr Anesth Reanim 2007;26(1):53-73.
  5. Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, et al. Early goal-di- rected therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001;345(19):1368-77.
  6. Boyd JH, Forbes J, Nakada TA, Walley KR, Russell JA. Fluid resuscitation in septic shock: a positive fluid balance and elevated central venous pressure are associated with in- creased mortality. Crit Care Med 2011;39(2):259-65.
  7. Samu save sepsis: early goal directed therapy in pre hospital care of patients with se- vere sepsis and/or septic shock (SSS). ClinicalTrials.gov Identifier: NCT02473263.

    The risk stratification in community- acquired pneumonia

    We have greatly enjoyed reading the recently published article by Zhou and colleagues [1]. The authors evaluated 226 consecutive adult patients with community-acquired pneumonia admitted in ED of a Tertiary teaching hospital and investigated the risk stratification and Prognostic prediction value of procalcitonin and several clinical se- verity scores on patients with community-acquired pneumonia in ED. They found that combination of procalcitonin and The Sequential Organ Failure Assessment score achieved the highest superiority to other combinations in predicting not only severe CAP, but also 28-day mortality.

    Despite the efficacy of modern treatment, CAP is the leading cause of death due to infection and also a frequent cause of medical consulta- tions. Prognostic scores, like the CURB-65 (confusion, urea, respiratory rate, arterial blood pressure and age) score and the pneumonia severity index have been developed and validated to estimate the risk of adverse outcome and to register a patient with CAP for hospital admission. Bio- markers are also useful tools in the diagnosis, prognostics and follow-up treatment of CAP [2]. Since CAP is an infectious disease, commonly-used laboratory parameters include the C-reactive protein, white blood cell count, and procalcitonin. However, recent studies showed that cardiac complications are common in patients with CAP, and cardiovascular biomarkers are found to be superior compared to inflammatory

    raphy [5] has been shown to be associated with increased rates of ad- verse events in patients with CAP.

    Therefore, we think that combination of biomarkers of cardiac dys- function with well-known biomarkers such as procalcitonin and CRP or combination of transthoracic echocardiography findings with classi- cal prognostic scores, like the CURB-65 and SOFA, could improve the performance of single predictors in patients with CAP.

    Eda Ozlek

    Mugla University, Faculty of Medicine, Department of Cardiology, Turkey

    Funda Sungur Biteker

    Yatagan State Hospital, Department of Infectious Diseases and Clinical

    Microbiology, Turkey

    Cem Cil Oguzhan Celik Bulent Ozlek? Volkan Dogan Murat Biteker

    Mugla University, Faculty of Medicine, Department of Cardiology, Turkey

    ?Corresponding author at: Mugla Sitki Kocman Universitesi Tip Fakultesi, Orhaniye Mah. Haluk Ozsoy Cad., 48000, Mugla, Turkey. E-mail address: [email protected] (B. Ozlek).

    4 May 2018

    https://doi.org/10.1016/j.ajem.2018.05.061

    References

    Zhou H, Guo S, Lan T, Ma S, Zhang F, Zhao Z. The risk stratification and prognostic pre- diction value of procalcitonin and clinical severity scores on patients with community-acquired pneumonia in emergency department: prediction value of procalcitonin and severity scores for CAP. Am J Emerg Med 2018. https://doi.org/10. 1016/j.ajem.2018.03.050 (in press, Mar 21. pii: S0735-6757(18)30242-0).

  8. Biteker FS, Yildirim B. Biomarkers in community-acquired pneumonia. J Infect 2015 Dec;71(6):695-6.
  9. Yildirim B, Biteker FS, Basaran O, Alatas OD, Acar E, Sozen H, Dogan V, Beydilli H, Caylak SD. Is there a potential role for echocardiography in adult patients with CAP? Am J Emerg Med 2015 Nov;33(11):1672-6.
  10. Biteker FS, Biteker M, Basaran O, Dogan V, Ozlek B, Yildirim B, Ozlek E, Celik O. A small pericardial effusion is a marker of complicated hospitalization in patients with community-acquired pneumonia. J Crit Care 2018 Apr;44:294-9.
  11. Biteker FS, Basaran O, Dogan V, Caylak SD, Yildirim B, Sozen H. Prognostic value of transthoracic echocardiography and biomarkers of cardiac dysfunction incommunity-acquired pneumonia. Clin Microbiol Infect 2016 Dec;22(12) (1006. e1-1006).

    Ambu(R) AuraGain(TM) laryngeal mask as a method of airway management of patient entrapped in vehicle

    Sir,

    We read the article by Evrin et al. [1] investigating the use of Ambu(R) AuraGain(TM) laryngeal mask by firefighters with a great interest. Un- doubtedly, it is vitally important to keep looking for new methods of maintaining airway patency and to educate both medical and emer- gency services personnel in this aspect of medicine [2]. One group, from the emergency services personnel, which was examined by Evrin et al. [1] are lifeguards, however, firefighters are another professional

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