RT Journal Article
SR Electronic
T1 Prediction of complicated lower respiratory tract infections in older patients with diabetes
JF British Journal of General Practice
JO Br J Gen Pract
FD British Journal of General Practice
SP 564
OP 568
DO 10.3399/bjgp08X319620
VO 58
IS 553
A1 Leonie MAJ Venmans
A1 Jettie Bont
A1 Kees J Gorter
A1 Theo JM Verheij
A1 Guy EHM Rutten
A1 Eelko Hak
YR 2008
UL http://bjgp.org/content/58/553/564.abstract
AB Background Patients with diabetes have an elevated risk of developing complicated lower respiratory tract infections (LRTIs). However, up until now, GPs have not had the tools to assess individual risks.Aim To assess the applicability of an existing prediction rule for complicated LRTI among patients with diabetes.Design of study Retrospective cohort study.Setting The Utrecht GP Research Network.Method An existing rule that was used estimates the risk of 30-day hospitalisation or death following an episode of LRTI. Predictors were exacerbation of chronic obstructive pulmonary disease, or pneumonia, increasing age, heart failure, number of hospitalisations in the previous year, use of antibiotics in the previous month, diabetes medication, and prednisone use. Discriminative capacity of the rule was estimated in patients with diabetes. Other potential predictors from the original study were examined, to test for a potentially improved model.Results Of 445 episodes of LRTI in patients with diabetes, 68 had an outcome of hospitalisation or death within 30 days of diagnosis of LRTI (15.3%). Results showed good reliability of the model (goodness of fit test P = 0.16) and discriminative properties (area under the receiver operating characteristic curve: 0.79, 95% confidence interval = 0.73 to 0.86). No other predictors could be added. Patients with a lower-risk assignment (score ≤2) had a probability of 5.2%, and those with higher risks (score ≥7) had a probability of 36.6% for the composite endpoint of hospitalisation or death within 30 days of diagnosis of LRTI.Conclusion The use of a prediction rule may help GPs to assess the risk of hospitalisation or death in patients with diabetes who have an episode of LRTI.