Chest
Original ResearchChest InfectionsPneumonia Severity Index Class V Patients With Community-Acquired Pneumonia: Characteristics, Outcomes, and Value of Severity Scores
Section snippets
Study Subjects
The study was conducted in a 700-bed, tertiary care university hospital. All patients with CAP were prospectively followed from January 1996 to June 2003. CAP was defined as symptoms of lower respiratory tract infection plus new infiltrates seen on a chest radiograph and the absence of an alternative diagnosis. We included consecutively all patients classified on hospital admission as being in PSI-V (PSI index score, ≥ 130).4 Patients with a hospital admission in the previous month or those who
Baseline Characteristics
During the study period, CAP was diagnosed in 2,029 patients. Of these, 457 patients were classified as being in PSI-V with a mean (± SD) PSI of 154 ± 20 points (range, 131 to 234) points. The mean age was 79 ± 11 years (range, 33 to 102 years), and 70% of patients were men. Considering comorbidity, 277 patients (60%) had a previous diagnosis pulmonary disease, 166 patients (36%) had heart disease, 133 patients (29%) had a neurologic disorder, 115 patients (25%) had chronic renal disease, and
Discussion
This study has evaluated the profile and outcomes of patients with CAP and PSI-V in detail. Our results show that, despite a high mortality rate, only 20% of patients were admitted to the ICU. The patients treated in the ICU were younger and had less comorbidity. Mortality was high in ICU patients but was also relatively high in patients on the ward. The modified ATS severity rule had the best accuracy in predicting ICU admission and death. Finally, for the whole group of PSI-V CAP patients,
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This research was supported by Fondo de Investigaciones Sanitarias grant 02/0632, and Institut de Investigacions Biomédiques August Pi i Sunyer grant 2005 SGRQ/00822, and Centro de Investigacion Biomedica en Red-Enfermedades Respiratorias CB 06/06/0028. Dr. Mauricio Valencia received a research fellowship grant in 2002 funded by the European Respiratory Society.
The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.