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Thorax. May 2003; 58(5): 377–382.
PMCID: PMC1746657

Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study

Abstract

Background: In the assessment of severity in community acquired pneumonia (CAP), the modified British Thoracic Society (mBTS) rule identifies patients with severe pneumonia but not patients who might be suitable for home management. A multicentre study was conducted to derive and validate a practical severity assessment model for stratifying adults hospitalised with CAP into different management groups.

Methods: Data from three prospective studies of CAP conducted in the UK, New Zealand, and the Netherlands were combined. A derivation cohort comprising 80% of the data was used to develop the model. Prognostic variables were identified using multiple logistic regression with 30 day mortality as the outcome measure. The final model was tested against the validation cohort.

Results: 1068 patients were studied (mean age 64 years, 51.5% male, 30 day mortality 9%). Age [gt-or-equal, slanted]65 years (OR 3.5, 95% CI 1.6 to 8.0) and albumin <30 g/dl (OR 4.7, 95% CI 2.5 to 8.7) were independently associated with mortality over and above the mBTS rule (OR 5.2, 95% CI 2.7 to 10). A six point score, one point for each of Confusion, Urea >7 mmol/l, Respiratory rate [gt-or-equal, slanted]30/min, low systolic(<90 mm Hg) or diastolic ([less-than-or-eq, slant]60 mm Hg) Blood pressure), age [gt-or-equal, slanted]65 years (CURB-65 score) based on information available at initial hospital assessment, enabled patients to be stratified according to increasing risk of mortality: score 0, 0.7%; score 1, 3.2%; score 2, 3%; score 3, 17%; score 4, 41.5% and score 5, 57%. The validation cohort confirmed a similar pattern.

Conclusions: A simple six point score based on confusion, urea, respiratory rate, blood pressure, and age can be used to stratify patients with CAP into different management groups.

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Selected References

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  • Bartlett JG, Dowell SF, Mandell LA, File Jr TM, Musher DM, Fine MJ. Practice guidelines for the management of community-acquired pneumonia in adults. Infectious Diseases Society of America. Clin Infect Dis. 2000 Aug;31(2):347–382. [PubMed]
  • Mandell LA, Marrie TJ, Grossman RF, Chow AW, Hyland RH. Canadian guidelines for the initial management of community-acquired pneumonia: an evidence-based update by the Canadian Infectious Diseases Society and the Canadian Thoracic Society. The Canadian Community-Acquired Pneumonia Working Group. Clin Infect Dis. 2000 Aug;31(2):383–421. [PubMed]
  • Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, Coley CM, Marrie TJ, Kapoor WN. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997 Jan 23;336(4):243–250. [PubMed]
  • Neill AM, Martin IR, Weir R, Anderson R, Chereshsky A, Epton MJ, Jackson R, Schousboe M, Frampton C, Hutton S, et al. Community acquired pneumonia: aetiology and usefulness of severity criteria on admission. Thorax. 1996 Oct;51(10):1010–1016. [PMC free article] [PubMed]
  • Lim WS, Macfarlane JT, Boswell TC, Harrison TG, Rose D, Leinonen M, Saikku P. Study of community acquired pneumonia aetiology (SCAPA) in adults admitted to hospital: implications for management guidelines. Thorax. 2001 Apr;56(4):296–301. [PMC free article] [PubMed]
  • Lim WS, Lewis S, Macfarlane JT. Severity prediction rules in community acquired pneumonia: a validation study. Thorax. 2000 Mar;55(3):219–223. [PMC free article] [PubMed]
  • Qureshi KN, Hodkinson HM. Evaluation of a ten-question mental test in the institutionalized elderly. Age Ageing. 1974 Aug;3(3):152–157. [PubMed]
  • Concato J, Feinstein AR. Monte Carlo methods in clinical research: applications in multivariable analysis. J Investig Med. 1997 Aug;45(6):394–400. [PubMed]
  • Riquelme R, Torres A, El-Ebiary M, de la Bellacasa JP, Estruch R, Mensa J, Fernández-Solá J, Hernández C, Rodriguez-Roisin R. Community-acquired pneumonia in the elderly: A multivariate analysis of risk and prognostic factors. Am J Respir Crit Care Med. 1996 Nov;154(5):1450–1455. [PubMed]
  • Janssens JP, Gauthey L, Herrmann F, Tkatch L, Michel JP. Community-acquired pneumonia in older patients. J Am Geriatr Soc. 1996 May;44(5):539–544. [PubMed]
  • Marrie TJ, Durant H, Yates L. Community-acquired pneumonia requiring hospitalization: 5-year prospective study. Rev Infect Dis. 1989 Jul-Aug;11(4):586–599. [PubMed]
  • Ortqvist A, Hedlund J, Grillner L, Jalonen E, Kallings I, Leinonen M, Kalin M. Aetiology, outcome and prognostic factors in community-acquired pneumonia requiring hospitalization. Eur Respir J. 1990 Nov;3(10):1105–1113. [PubMed]
  • Farr BM, Sloman AJ, Fisch MJ. Predicting death in patients hospitalized for community-acquired pneumonia. Ann Intern Med. 1991 Sep 15;115(6):428–436. [PubMed]
  • Fine MJ, Smith MA, Carson CA, Mutha SS, Sankey SS, Weissfeld LA, Kapoor WN. Prognosis and outcomes of patients with community-acquired pneumonia. A meta-analysis. JAMA. 1996 Jan 10;275(2):134–141. [PubMed]
  • Ewig S, Bauer T, Hasper E, Pizzulli L, Kubini R, Lüderitz B. Prognostic analysis and predictive rule for outcome of hospital-treated community-acquired pneumonia. Eur Respir J. 1995 Mar;8(3):392–397. [PubMed]
  • Hasley PB, Albaum MN, Li YH, Fuhrman CR, Britton CA, Marrie TJ, Singer DE, Coley CM, Kapoor WN, Fine MJ. Do pulmonary radiographic findings at presentation predict mortality in patients with community-acquired pneumonia? Arch Intern Med. 1996 Oct 28;156(19):2206–2212. [PubMed]
  • Lim WS, Macfarlane JT. Defining prognostic factors in the elderly with community acquired pneumonia: a case controlled study of patients aged > or = 75 yrs. Eur Respir J. 2001 Feb;17(2):200–205. [PubMed]
  • van Kasteren ME, Wijnands WJ, Stobberingh EE, Janknegt R, van der Meer JW. Optimaliseren van het antibioticabeleid in Nederland. II. SWAB-richtlijnen voor antimicrobiële therapie bij thuis opgelopen pneumonie en bij nosocomiale pneumonie. Ned Tijdschr Geneeskd. 1998 Apr 25;142(17):952–956. [PubMed]
  • Fine MJ, Singer DE, Hanusa BH, Lave JR, Kapoor WN. Validation of a pneumonia prognostic index using the MedisGroups Comparative Hospital Database. Am J Med. 1993 Feb;94(2):153–159. [PubMed]
  • Niederman MS, Mandell LA, Anzueto A, Bass JB, Broughton WA, Campbell GD, Dean N, File T, Fine MJ, Gross PA, et al. Guidelines for the management of adults with community-acquired pneumonia. Diagnosis, assessment of severity, antimicrobial therapy, and prevention. Am J Respir Crit Care Med. 2001 Jun;163(7):1730–1754. [PubMed]

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