title: Community-acquired pneumonia as medical emergency: predictors of early deterioration.
abstract: BACKGROUND
  Early organ dysfunction determines the prognosis of community-acquired pneumonia (CAP), and recognition of CAP as a medical emergency has been advocated.
  
  
  OBJECTIVE
  To characterise patients with 'emergency CAP' and evaluate predictors for very early organ failure or death.
  
  
  METHODS
  3427 prospectively enrolled patients of the CAPNETZ cohort were included. Emergency CAP was defined as requirement for mechanical ventilation or vasopressor support (MV/VS) or death within 72 h and 7 days after hospital admission, respectively. To determine independent predictors, multivariate Cox regression was employed. The ATS/IDSA 2007 minor criteria were evaluated for prediction of emergency CAP in patients without immediate need of MV/VS.
  
  
  RESULTS
  140 (4%) and 173 (5%) patients presented with emergency CAP within 3 and 7 days, respectively. Hospital mortality of patients presenting without immediate need of MV/VS was highest. Independent predictors of emergency CAP were the presence of focal chest signs, home oxygen therapy, multilobar infiltrates, altered mental status and altered vital signs (hypotension, raised respiratory or heart rate, hypothermia). The ATS/IDSA 2007 minor criteria showed a high sensitivity and negative predictive value, whereas the positive predictive value was low. Reduction to 6 minor criteria did not alter accuracy.
  
  
  CONCLUSIONS
  Emergency CAP is a rare but prognostic relevant condition, mortality is highest in patients presenting without immediate need of MV/VS. Vital sign abnormalities and parameters indicating acute organ dysfunction are independent predictors, and the ATS/IDSA 2007 minor criteria show a high negative predictive value.
authors.affiliation: Division of Pulmonology, Medical Department I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Kolditz
authors.affiliation: Department of Respiratory and Infectious Diseases, Thoraxzentrum Ruhrgebiet, EVK Herne and Augusta-Kranken-Anstalt Bochum, Bochum, Germany.
authors.forename: Santiago
authors.initials: S
authors.lastname: Ewig
authors.affiliation: Department of Respiratory and Infectious Diseases, Thoraxzentrum Ruhrgebiet, EVK Herne and Augusta-Kranken-Anstalt Bochum, Bochum, Germany.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Klapdor
authors.affiliation: Department of Internal Medicine, Infectious Diseases and Pulmonary Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany Department of Pulmonology, Klinikum Ernst von Bergmann, Potsdam, Germany CAPNETZ Stiftung, Hannover, Germany.
authors.forename: Hartwig
authors.initials: H
authors.lastname: Schütte
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Hospital Jena, Jena, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Winning
authors.affiliation: CAPNETZ Stiftung, Hannover, Germany Division of Molecular and Clinical Infectious Diseases, Med. Clinic III, University of Lübeck, Lübeck, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Rupp
authors.affiliation: Department of Internal Medicine, Infectious Diseases and Pulmonary Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany CAPNETZ Stiftung, Hannover, Germany.
authors.forename: Norbert
authors.initials: N
authors.lastname: Suttorp
authors.affiliation: CAPNETZ Stiftung, Hannover, Germany Department of Respiratory Medicine, Medizinische Hochschule Hannover, Hannover, Germany Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL).
authors.forename: Tobias
authors.initials: T
authors.lastname: Welte
authors.affiliation: CAPNETZ Stiftung, Hannover, Germany Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL) Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Gernot
authors.initials: G
authors.lastname: Rohde
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000503:physiopathology; D003371:Cough / Q000382:microbiology; D004630:Emergencies; D004638:Emergency Treatment / Q000379:methods*; D005260:Female; D005334:Fever / Q000382:microbiology; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012107:Research Design; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013183:Sputum / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents
keywords: Pneumonia