Efectividad de la puntuación CURB-65 extendida en pacientes diagnosticados con neumonía asociada a la comunidad en el Hospital General del Norte de Guayaquil (IESS Los Ceibos).

Abstract

Background: Acquired pneumonia in the Community is an acute lower respiratory tract infection that is acquired outside the hospital, with or without the presence of pulmonary infiltrates on the chest radiograph that is confirmed by laboratory tests. Clinical manifestations can occur outside the hospital, 72 hours after hospitalization or 14 days after hospital discharge. The delay in diagnosis and medical treatment, as in the case of late admission to the intensive care unit (ICU), contributes to the increase in mortality. Our objective was to evaluate the effectiveness of the new score for patients with Acquired Pneumonia in the Community (NAC) called expand-CURB-65, which is determined by confusion, urea (> 7 mmol), respiratory rate (≥ 30 rpm), systolic blood pressure (<90 mmHg), diastolic blood pressure (<60 mmHg), age (≥ 65 years), lactate dehydrogenase - LDH (> 230 U / l), albumin (<3.5 g / dl), platelet count ( <100 × 10 9 / l). The expand-CURB-65 is an objective scoring system, capable of demonstrating a new score of simpler, more effective and accurate severity for the evaluation of the severity of NAC. Objective: To compare the systems of score CURB 65 vs CURB 65 Expand to determine the effectiveness of predicting the state of severity of the disease at the entrance of diagnostic patients with community-associated pneumonia in the hospitalization area of the department of internal medicine and unit of intensive care of the Hospital General del Norte de Guayaquil (IESS Los Ceibos) in the period from September 2017 to September 2018. Materials and Methods: In this cross-sectional, observational, prospective study. We reviewed 100 patients diagnosed with community-acquired pneumonia (CAP) who were hospitalized in the departments of internal medicine and intensive care unit of the Hospital General del Norte de Guayaquil (IESS Los Ceibos), who met the inclusion criteria, and presentation of the variables proposed in our study. Results: The admission rate to the ICU was 9%, the average number of days of hospital stay was 12 days and the 30- day mortality rate was14%. Among the variables analyzed as risk factors through chi square test with a p value <0.05 demonstrated significant association for age> = 65 years old, confussion and albumin. The study failed to demonstrate the EXTENDED CURB 65 score was more sensitive than CURB 65, although it presented an AUC (0.635) with a confidence interval of 95% slightly higher than AUC (0.613) by CURB 65 score. In the present study, the AUC (0.802) with p value <0.03 of the ROC curve, the sensitivity of the EXTENDED CURB 65 score to predict admission to ICU was higher than that achieved through the CURB 65. Conclusions: In this study, he use of EXTENDED CURB 65, has not shown a greater efficiency for evaluation of CAP severity, but has shown efficiency of predicting the requirement of UCI for a CAP patient.