The alveolar-arterial gradient, pneumonia severity scores and inflammatory markers to predict 30-day mortality in pneumonia

• Published in: The American journal of emergency medicine 2020-09, Vol.38 (9), p.1796-1801
• Main Authors: Avci, Sema, Perincek, Gokhan
• Format: Article
• Language: English
• Subjects: Accuracy; Albumin; Alveolar-arterial oxygen gradient; Alveoli; Antibiotics; Blood; Blood platelets; Cardiovascular disease; Chronic illnesses; Community-acquired pneumonia; Creatinine; Demography; Emergency medical care; Homeless people; Independent sample; Infections; Inflammation; Laboratories; Lactic acid; Medical prognosis; Mortality; Mortality risk; Normal distribution; Patients; Phosphorus; Pneumonia; Procalcitonin; Statistical analysis; Survival; Tuberculosis; Uric acid
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2020.05.048

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). 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. 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. A-a O2 gradient, A-a O2 difference and albumin are potent predictors of 30-day mortality in CAP patients in the ED.