Desempeño del SOAR como predictor de severidad de la neumonía adquirida en la comunidad
Palabras clave:
Neumonia mortalidad, Índice de gravedad de la enfermedad, Valor predictivo de las pruebas, Infecciones adquiridas en la comunidadResumen
Objetivo: Evaluar el desempeño del score SOAR como predictor de severidad en la neumonía adquirida en la comunidad (NAC), y de forma comparativa con los scores CURB-65 e Índice de Gravedad de la Neumonía (PSI).
Pacientes y Método: Es un estudio retrospectivo, observacional, de corte transversal. Incluyó pacientes mayores de 14 años con diagnóstico al ingreso de NAC durante un año calendario. Se calculó CURB-65, PSI y el SOAR al ingreso. Se valoró la gravedad de la NAC evaluando el requerimiento de terapia intensiva, necesidad de asistencia mecánica ventilatoria o muerte intrahospitalaria.
Resultados: Se incluyeron 274 pacientes, 178 (65.0%) hombres, edad promedio 49±18.1 años. Presentaron bacteriemia 62 (22.6%) pacientes, siendo el Streptococcus pneumoniae el microorganismo aislado más frecuentemente (n=30, 48.4%). El score SOAR fue eficaz para valorar ingreso a UCI en la NAC con un OR: OR=7.7. IC=3.8-15.6 (p<0.001), y requerimiento de ARM con un OR=9.9. IC=4.2-23.5 (p<0.001). El score SOAR predijo mortalidad eficazmente (p<0.001), con un OR: 12.2 IC: 3.9-38.1, S: 89.5%, E: 76.5%, VPP: 26.3%, VPN: 98.0% aunque el PSI y el CURB-65 fueron superiores, con un OR: 26.6 y 32.4 respectivamente.
Conclusión: Un puntaje de score SOAR clasificado como severo (≥2 puntos) indica riesgo aumentado para formas severas de NAC. El score SOAR puede utilizarse de forma alternativa o complementaria, en conjunto al indispensable juicio médico.
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