Rendimiento de la escala Severe Community Acquired Pneumonia (SCAP) para la predicción de desenlaces clínicos en neumonía

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Luis F. Reyes-Velasco
Alirio R. Bastidas-Goyes
Juan M. Leguízamo-Isaza
Daniela Urbina-Jaramillo
Manuela Jaramillo-Sierra
Julián M. Rozo-Prieto
Melissa A. Peñata-Hoyos
Andrés F. Méndez-Bonilla
Luz A. Cepeda-Cortés
Ana M. Duque-Giraldo
Dayana A. Arjona-Granados
Nicolás Leal-Poveda
Laura M. Quintero-Salgado

Resumen

Objetivo: evaluar el desempeño de la escala Severe Community Acquired Pneumonia (SCAP) en pacientes con neumonía adquirida en la comunidad (NAC) para la predicción de muerte intrahospitalaria, a 30 días, requerimiento de ventilación mecánica invasiva (VMi) y de soporte vasopresor. Metodología: estudio de cohorte retrospectivo con análisis de prueba diagnóstica de la escala SCAP en pacientes con NAC conforme a los criterios de la American Thoracic Society (ATS) y la Infectious Diseases Society of America (IDSA). Se estimó una escala SCAP adicional reemplazando la PaO2/FiO2<250 por la SpO2/ FiO2<400. Se calcularon los OR crudos y ajustados por cada variable de los puntajes con los desenlaces de interés, así como las áreas bajo la curva de la característica operativa del receptor (ACOR). Se compararon las ACOR con la prueba De-Long, considerando una p<0,05 estadísticamente significativa. Resultados: se incluyeron 1795 pacientes en el análisis definitivo, 13,6% fallecieron en el hospital y 15% en el seguimiento a 30 días, 10,8% requirieron VMi y 11,4% soporte vasopresor. La sensibilidad de la escala SCAP para la predicción de los cuatro desenlaces previamente mencionados fue mayor que la del puntaje CURB-65. El rendimiento de la escala no se modifica al emplear como criterio la SpO2/FiO2<400. Conclusiones: la escala SCAP presenta un buen desempeño para la predicción de los desenlaces clínicos en neumonía, manteniendo su rendimiento cuando se utiliza la SpO2/FiO2<400.

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