title: Multimarker Prognostication for Hospitalized Patients with Community-acquired Pneumonia.
abstract: OBJECTIVE
  The optimal prognostic model for community-acquired pneumonia (CAP) remains unclear. In this study, we sought to identify independent predictors of 30-day mortality in patients with CAP and to determine whether adding specific prognostic factors to each of the two clinical prediction scores could improve the prognostic yield.
  
  
  METHODS
  This retrospective study involved 797 CAP patients who had been hospitalized at a tertiary referral center. The patients were categorized into two groups: those who survived and those who had died on or before 30 days after admission. Select clinical parameters were then compared between the two groups.
  
  
  RESULTS
  During the 30-day period, there were 72 deaths (9%). We constructed two models for a multivariate analysis: one was based on a high CURB-65 score (3-5) and the other on a high pneumonia severity index (PSI) class (V). In both models, a high CURB-65 score or a high PSI class, along with the presence of dyspnea, high Eastern Cooperative Oncology Group (ECOG) performance status (3-4), and a low serum albumin level, were independent predictors of 30-day mortality. In both the CURB-65-based and PSI-based models, the addition of dyspnea, high ECOG performance status, and hypoalbuminemia (<3 g/dL) enhanced the prognostic assessment, and subsequently, the c-statistics calculated with the use of three- or four- predictor combinations exceeded 0.8.
  
  
  CONCLUSIONS
  In addition to the CURB-65 or PSI, the clinical factors of dyspnea, the ECOG performance status, and serum albumin level may be independent predictors of 30-day mortality in CAP patients. When combined with the CURB-65 or PSI, these parameters provide additional evidence for predicting poor prognoses.
authors.affiliation: Department of Internal Medicine, Kyungpook National University School of Medicine, Korea.
authors.forename: So
authors.initials: S
authors.lastname: Yeon Lee
authors.forename: Seung-Ick
authors.initials: SI
authors.lastname: Cha
authors.forename: Hyewon
authors.initials: H
authors.lastname: Seo
authors.forename: Serim
authors.initials: S
authors.lastname: Oh
authors.forename: Keum-Ju
authors.initials: KJ
authors.lastname: Choi
authors.forename: Seung-Soo
authors.initials: SS
authors.lastname: Yoo
authors.forename: Jaehee
authors.initials: J
authors.lastname: Lee
authors.forename: Shin-Yup
authors.initials: SY
authors.lastname: Lee
authors.forename: Chang-Ho
authors.initials: CH
authors.lastname: Kim
authors.forename: Jae-Yong
authors.initials: JY
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017714:Community-Acquired Infections / Q000401:mortality*; D005260:Female; D006305:Health Status Indicators; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010361:Patients; D011014:Pneumonia / Q000401:mortality*; D011379:Prognosis; D012189:Retrospective Studies; D012709:Serum Albumin; D012720:Severity of Illness Index
chemical_list: D012709:Serum Albumin