Prognostic Score for ICU Mortality in Patients with Community-Acquired Pneumonia

Definition of community acquired pneumonia:

(1) admission from home or nursing home

(2) presence of a new pulmonary infiltrate on chest X-ray

(3) acute onset with at least 1 major OR 2 minor findings

(3a) major: cough, sputum production, fever

(3b) minor: dyspnea, pleuritic chest pain, altered mental state, pulmonary consolidation on physical examination, total leukocyte count > 12,000 per µL

Criteria for admission to the ICU:

(1) if patient needed immediate mechanical ventilation

(2) if patient was judged to be in an unstable condition that required comprehensive care (potential need for ventilatory support, septic shock,  neurological disturbances, etc.)

(after Table 4, page 1311)

where:

• Aspiration pneumonia was diagnosed in patients with altered mental status, abnormal gag reflex, and X-ray infiltrates  in the superior or basilar segments of the lower lobes or the posterior segment of the upper lobe.

• Shock = (a) sustained (>=1 hour) decrease in systolic blood pressure of at least 40 mm Hg from baseline, or < 90 mm Hg after adequate volume replacement and (b) in the absence of antihypertensive agents.

• Anticipated death serves as a measure of concurrent and underlying disease.

• Immunosuppression = WBC count < 1,000 per µL, recent use of systemic corticosteroids, recent use of cytotoxic drugs, radiation treatment or asplenia.

• Grading of sepsis (implemented under microbiology and infectious disease): Elebute EA, Stoner HB. The grading of sepsis. Br J Surg. 1983; 70: 29.

• Glasgow Coma score (implemented under neurology): Teasdale G, Jennet B. Assessment of coma and impaired consciousness. Lancet. 1974; 2: 81-84.

• SAPS (implemented under critical care): Le Gall JR, Loirat P, et al. Simplified acute physiologic score for intensive care patient. Lancet. 1983; 2: 741.

• OSF (implemented under critical care): Knaus WA, Draper EA, et al. Prognosis in acute organ system failure. Ann Surg. 1985; 202: 685-693.

• Antimicrobial combination

• Initial antimicrobial therapy was considered effective if the clinical condition improved and fever lessened within the first 72 hours of treatment.

prognostic score =

= SUM(values for conditions present)

Interpretation:

• A score >= 2.5 predicts death with a positive predictive value of 0.92, sensitivity of 0.61 and specificity of 0.98.

(after Figure 1, page 1311)