The following is the summary of “Including Organ Dysfunctions in a Predictive Score for Nosocomial Pneumonia After Cardiothoracic Surgery” published in the December 2022 issue of Respiratory Care by Kortchinsky, et al. 


The clinical diagnosis of pneumonia developed in the intensive care unit following cardiothoracic surgery is difficult. In half of all cases, the Johanson criteria (a chest radiograph infiltrate, purulent tracheal secretions, fever, and leukocytosis) are insufficient. Instead, diagnosis might be helped by a high Clinical Pulmonary Infection Score (CPIS) and an increase of 2 points or more in the Sequential Organ Failure Assessment (SOFA) score. The purpose of this research was to compare the ability of CPIS and SOFA↑ ≥2 to predict ICU-acquired pneumonia in patients who had undergone cardiothoracic surgery.

A prospective observational design was adopted in our experiments. Clinical and laboratory characteristics were used in a derivation cohort to refine the Spiegelhalter-Knill-Jones scoring system, which may include the CPIS or SOFA↑ ≥ 2. ICU-acquired pneumonia had to be shown by a positive quantitative lung sample culture. For both sets of criteria, the AUROC was calculated. Finally, a validation cohort was used to assess the best system. The results show that a total of 216 suspected instances of ICU-acquired pneumonia were found in the validation cohort, while the derivation cohort had 172 individuals. 

The CPIS AUROC was 0.53±0.03 (P=.29), while the SOFA ↑ ≥2 AUROC was 0.54±0.03. SOFA ↑ ≥2 (SOFA model) was improved so that the AUROC was 0.65 ±0.03 (P<.001) by including purulent tracheal secretions and leukocytosis. The AUROC was only slightly improved by including catecholamine use in CPIS (CPIS model), rising to 0.57± 0.03. It was clear that the SOFA model could accurately forecast high or low probabilities. A clinical scoring system containing at least SOFA↑ ≥ 2 significantly improved ICU-acquired pneumonia prediction in participants after cardiothoracic surgery.

Source: rc.rcjournal.com/content/67/12/1558