Introduction: Even in the 21st century, pneumonia represents a serious medical problem with high morbidity and mortality. The aim of the clinical study was to describe the group of patients with severe community-acquired pneumonia and to evaluate the predictive efficiency of the applied scoring systems.
Methods: A prospective multicenter observational study was carried out in the period 1/9/2017 – 1/7/2021 in three Czech ICU. Patients with community-acquired pneumonia requiring ICU admission within 48 hours of hospital admission were included in the study.
Anamnestic data, clinical manifestations, etiological agent, antibiotic treatment, applied intensive care methods and treatment outcomes were recorded. A total of ten scoring systems were applied to describe the clinical severity of pneumonia and their reliability was evaluated in terms of predicting mortality and the need for intensive care. Due to the current covid-19 pandemic, patients with coronavirus infection were also included in the study; for analysis, the patients were divided into two groups – covid and non-covid.
Results: A total of 315 patients, 68.3% men and 31.7% women, with the age range of 18–88 years and an average age of 61.1 ± 14.1 years, were included in the study. Fifty-nine percent of patients had at least one serious comorbidity, most commonly diabetes mellitus (29.5%), chronic lung disease (19.7%) and ischaemic heart disease (16.5%). Obesity was also common;
the average BMI was 30.6. The etiology was proved in 87.3% of patients. The most common pathogens detected were SARS-CoV-2 in 194 patients, i.e., 61.6% of the entire group. In the group of 121 patients with non-covid pneumonia, the most common pathogens were
pneumococci and influenza viruses. Mechanical ventilation was necessary in 51.4% of cases with an average duration of 16.1 days. Catecholamines were needed in 55.6% and renal replacement techniques in 9.2% of patients. The average length of stay in the ICU was 15.7 days, and the overall mortality reached 28.9%. A significantly higher mortality was found in patients with pneumonia due to coronavirus compared to other pathogens (39.4% vs. 12.4%).
CURB-65 score proved to be the most reliable scoring system in predicting mortality (AUC 0.676), and SMART-COP in predicting the need for intensive care (AUC 0.689).
Conclusion: The presented work describes the characteristics of severe community-acquired pneumonia in a representative sample of patients in the Czech Republic. It highlights the importance of the causative pathogens preventable by vaccination. Based on the established predictive reliability, it allows to recommend the routine use of the CURB-65 and SMART- COP scoring systems for determining the severity of the disease.
