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Ann Intern Med. 1991 Sep 15;115(6):428-36.

Predicting death in patients hospitalized for community-acquired pneumonia.

Author information

1
University of Virginia Health Sciences Center, Charlottesville.

Abstract

OBJECTIVE:

To validate a previously reported discriminant rule for predicting mortality in adult patients with primary community-acquired pneumonia and to determine which factors available at hospital admission predict a fatal outcome among such patients.

DESIGN:

Historical cohort study.

SETTING:

University hospital.

PATIENTS:

Adults admitted to the hospital for community-acquired pneumonia.

MEASUREMENTS:

Using stepwise logistic regression, we analyzed prognostic factors (data available at admission and recorded in the medical record) that showed a univariate association with mortality. The predictive values of three discriminant rules were measured to validate the results of a previous study.

MAIN RESULTS:

Of 245 patients, 20 (8.2%) died. Of 42 prognostic factors identified in previous studies, 8 were associated with mortality, but only a respiratory rate of 30/min or more, a diastolic blood pressure of 60 mm Hg or less, and a blood urea nitrogen of more than 7 mmol/L remained predictive in the multivariate analysis. A discriminant rule composed of these three variables was 70% sensitive and 84% specific in predicting mortality, yielding an overall accuracy of 82%.

CONCLUSION:

Tachypnea, diastolic hypotension, and an elevated blood urea nitrogen were independently associated with death from pneumonia in our study, confirming the value of a previously reported discriminant rule from the British Thoracic Society. This rule may be useful in triage decisions because it identifies high-risk patients who may benefit from special medical attention.

PMID:
1872491
DOI:
10.7326/0003-4819-115-6-428
[Indexed for MEDLINE]

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