Prognostic Score of Conte et al for Elderly Patients with Community-Acquired Pneumonia

 

Patient selection:

(1) age >= 65 years of age

(2) pneumonia is community (non-hospital) acquired

 

Parameters for score:

(1) age in years

(2) motor response

(3) serum creatinine

(4) comorbid conditions

(5) vital signs

 

Parameter	Finding	Points
age in years	>= 85	1
	< 85	0
motor response	impaired	1
	not impaired	0
serum creatinine in mg/dL	>= 1.5 mg/dL	1
	< 1.5 mg/dL	0
comorbid condition	present	2
	absent	0
vital signs (temperature, heart rate, systolic blood pressure)	one or more abnormal	2
	all normal	0

 

where:

• impaired motor response = failure to exhibit a motor response to verbal stimuli

• comorbid conditions = acute or chronic leukemia, Hodgkin's or non-Hodgkin's lymphoma, multiple myeloma, any cancer with local or distant metastases, hepatic failure, cirrhosis, chemotherapy or radiotherapy 3-12 months prior to admission (within past year but not 2 months before admission), or a collagen vascular disease

• abnormal vital signs: temperature < 36.1°C, heart rate > 110 beats per minute, systolic blood pressure < 90 mm Hg

 

risk score =

= (points for age) + (points for motor response) + (points for creatinine) + (points for comorbid condition) + (points for vital signs)

 

Interpretation:

• minimum score: 0

• maximum score: 7

 

Risk Score	Stage	Risk	Mortality
0	1	low	4%
1 or 2	2	low-intermediate	11%
3 or 4	3	intermediate-high	23%
5, 6 or 7	4	high	41%

 

Other factors associated with hospital mortality (page 22):

(1) admission from skilled nursing facility rather than home or noninstitutional setting

(2) abnormal functional status (urinary incontinence, impaired physical mobility)

(3) abnormal consciousness

(4) respirations > 30 breaths per minute

(5) laboratory findings associated with dehydration, other than creatinine (BUN >= 20 mg/dL, serum sodium < 130 or > 145 mmol/L)

(6) laboratory findings associated with sepsis (WBC count < 4,000 or > 20,000 cells per microliter)

(7) glucose < 60 or > 200 mg/dL