Community-acquired pneumonia : a potentially lethal emergency?

Community-acquired pneumonia (CAP) is a major health problem with a very high prevalence and mortality. Mortality can reach 13% among hospitalized patients and nearly 50% in the long term (5 y). Similarly, acute coronary syndrome is a life-threatening condition for which clinical management has greatly improved because of effective protocols of prehospital care and evidence-based interventions in the hospital, within well-defined timescales. Unfortunately, CAP management cannot be compared with that of acute coronary syndrome in terms of risk stratification and action protocols. In fact, CAP continues to be the main cause of severe sepsis in hospitalized patients; early evaluation is fundamental, especially in the first 24 hours, when mortality is high. Current risk-stratification tools for CAP are designed primarily to predict mortality and identify low-risk patients, which is valuable for ambulatory treatment, whereas the detection of high-risk patients remains suboptimal. Recent attempts to improve predictive tools, with the development of new biomarkers and alternative scoring systems, are discussed.