New Markers in Prognosis of Severe Community - Acquired Pneumonia

Community-acquired pneumonia (CAP) is the most common cause of death among infectious diseases. During the management of pneumonia, it is often uncertain when the disease may turn into severe form. The first definition of severe CAP was provided by the ATS Guidelines. Definition was built up around simple clinical and radiographic criteria reflecting the actual illness. The assessment of disease severity is valuable for clinicians caring for patients with severe CAP. The Pneumonia Severity Index (PSI) and CURB-65 (Confusion, Urea nitrogen, Respiratory rate, Blood pressure, age ≥65 years) are usually employed to predict the prognosis of CAP. However, the accuracy of PSI and CURB-65 for predicting outcomes has been challenged. New biomarkers may be useful for improving the outcome prediction in PSI classes I-V and high-risk CURB-65 score categories. Patients with severe form of the disease have benefit from admission to the intensive care unit. We must recognize the right moment for admission.Elevated concentrations of cytokines and markers reflect the complex changes in the immune response to microorganisms, and are associated with alterations of the neuroendocrine and vascular systems. Physicians must understand the problems associated with the pathogenesis of severe pneumonia and to apply the basic principles to guide the effective management.A lot of biomarker tests demonstrate independent prognostic factors for either 30-day or in-hospital mortality, including procalcitonin, triggering receptor expressed on myeloid cells-1 (TREM-1), proadrenomedullin, CRP, pro-atrial natriuretic peptide and pro-vasopressin. Further study of these remarkable plasma proteins is necessary, aiming to treat CAP more efficiently.