Abstract
Objective
The objective of this study was to evaluate the association of elevated alveolar-arterial
oxygen (A-a O2) gradient with risk of mortality in hospitalized patients with community-acquired
pneumonia (CAP).
Methods
This prospective study included 206 patients diagnosed with CAP admitted to the ED.
Demographics, comorbidities, arterial blood gas, serum electrolytes, liver-renal functions,
complete blood count, NLR, PLR, CRP, CAR, procalcitonin, A-a O2 gradient, expected A-a O2 and A-a O2 difference were evaluated. PSI and CURB-65 scores were classified as follow: a) PSI
low risk (I-III) and moderate-high risk (IV-V) groups; b) CURB-65; low risk (0–2)
and high risk (3–5) groups.
Results
The survival rates of the PSI class (I-III) were significantly higher than the ones
of the PSI class (IV-V) (92.1% vs. 62.9%, respectively). The percentage of survivors
of the CURB-65 score (0–2) group (81.9%) was higher than the survivors of CURB-65
score (3–5) group (27.8%). Creatinine, BUN, uric acid, phosphorus, RDW, CRP, CAR,
procalcitonin, lactate, A-a 02 gradient, expected A-a 02 and A-a 02 difference were significantly higher and basophil was lower in non-survivors. A-a
O2 gradient (AUC 0.78), A-a O2 difference (AUC 0.74) and albumin (AUC 0.80) showed highest 30-day mortality prediction.
NLR (AUC 0.58) and PLR (AUC 0.55) showed lowest 30-day mortality estimation. Procalcitonin
(AUC 0.65), PSI class (AUC 0.81) and PSI score (AUC 0.86) indicated statistically
significant higher 30-day mortality prediction.
Conclusion
A-a O2 gradient, A-a O2 difference and albumin are potent predictors of 30-day mortality in CAP patients
in the ED.
Keywords
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Article Info
Publication History
Published online: May 22, 2020
Accepted:
May 17,
2020
Received in revised form:
May 16,
2020
Received:
March 16,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
