Prediction of mortality in community-acquired pneumonia in hospitalized patients

Musonda, Patrick, Sankaran, Prasanna, Myint, Phyo K., Kamath, Ajay V., Subramanian, Deepak N., Smith, Alexandra C., Prentice, Philippa and Tariq, Syed M. (2011) Prediction of mortality in community-acquired pneumonia in hospitalized patients. American Journal of the Medical Sciences, 342 (6). pp. 489-493. ISSN 0002-9629

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Introduction: Community-acquired pneumonia (CAP) is common and associated with a significant mortality. Currently recommended criteria to assess severity of CAP could be improved. Methods: We derived 2 new criteria CARSI [confusion, age (<65, ≥65 to <85 or≥ 85), respiratory rate and shock index] and CARASI, where shock index is replaced by temperature-adjusted shock index based on previous observations. By using data of a prospective study performed in Norfolk and Suffolk, United Kingdom, we compare these new indices with the CURB-65 criteria. Results: A total of 190 patients were included (men, 53%). The age range was 18 to 101 years (median, 76 years). There were a total of 54 deaths during a 6-week follow-up, all within 30 days of admission. Sixty-five (34%) had severe pneumonia by CURB-65. Using CARSI and CARASI, 39 (21%) and 36 (19%) had severe pneumonia, respectively. Sensitivity was slightly less, but specificity was higher with CARSI and CARASI indices than that of CURB-65. Positive and negative predictive values in predicting death during 6-week follow-up were comparable among 3 indices examined. The receiver operating characteristic curve values (95% confidence interval) for the criteria were 0.67 (0.60–0.75) for CURB-65, 0.64 (0.60–0.71) for CARSI and 0.64 (0.57–0.71) for CARASI. Comparing receiver operating characteristic curves for CURB-65 versus CARSI, or CURB-65 versus CARASI, there was no evidence of a difference between the tools, P = 0.35 and 0.33, respectively. There was good agreement, which was strongly statistically significant (kappa = 0.56, P < 0.0001 and kappa = 0.54, P < 0.0001, respectively). Conclusions: Both CARSI and CARASI are useful in predicting deaths associated with CAP, including older patients, and may be particularly useful in the emergency and community settings.

Item Type: Article
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups: Faculty of Medicine and Health Sciences > Research Groups > Norwich Clinical Trials Unit
Depositing User: Rhiannon Harvey
Date Deposited: 30 Nov 2011 13:50
Last Modified: 16 Jan 2024 01:20
DOI: 10.1097/MAJ.0b013e31822cb95f

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