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Score of Saraya et al for Distinguishing Legionella pneumophilia Pneumonia from Streptococcus pneumoniae Pneumonia

Description

Saraya et al reported a score to help differentiate pneumonia caused by Legionella pneumophila from that caused by Streptococcus pneumonia. This can help guide antibiotic selection. The authors are from Kyorin University, Fukujuji Hospital and the National Institute of Infectious Diseases in Japan.


Patient selection: adult with pneumonia

 

Parameters:

(1) relative bradycardia (the heart rate is not as high as expected for a level of fever)

(2) serum LDH in IU/L

(3) serum C-reactive protein in mg/dL

(4) serum sodium concentration in mmol/L

 

Parameter

Finding

Points

relative bradycardia

absent

0

 

present

1

serum LDH

< 292 IU/L

0

 

>= 292 IU/L

1

serum CRP

< 21 mg/dL

0

 

>= 21 mg/dL

1

serum sodium

> 137 mmol/L

0

 

<= 137 mmol/L

1

 

total score =

= SUM(points for all 4 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 4

• A score >= 3 was associated with Legionella pneumonia.

 

Performance:

• The sensitivity was relatively low (0.36 for a score of 3; 0.27 for a score of 4).

• The specificity was high (1.00 for a score of 3; 0.98 for a score of 4).

• The area under the ROC curve was 0.68 for a score of 3 and 0.63 for score of 4.


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