Community-Acquired Pneumonia and Pneumonia Severity Index 20 (PSI-20): a study of 262 patients
Keywords:
Community-acquired pneumonia, Pneumonia Severity Index, risk classes, therapeutic, mortalityAbstract
Background: Several prognostic models in patients with Community-aquired Pneumonia (CAP), such as the Pneumonia Severity
Index 20 (PSI-20), have been devised, to assist the physician decide where to treat the patient initially.
Objectives: The main goal of this work was to assess the adequacy of the risk classes defi ned according to the PSI-20 and
hospital admission recommendations, as applied to our population. We also wanted to know the demographic characteristics
and other factors which affect mortality.
Methods: Retrospective study of all the patients admitted with
CAP to our infi rmary over a one-year period. The 20 PSI variables
were collected and the patients stratifi ed into risk classes (I-V).
Results Overall, 262 inpatients with CAP were included; 60%
were males, and 40% females, with a mean age of 72.9 years.
No signifi cant differences were observed in mortality regarding
sex, place of residence or presence of co-morbid conditions, but
there was a signifi cant difference in relation to age.
Treatment was empirical, with advantage for patients treated
with a combination of antibiotics.
The distribution of the patients across the risk classes was:
Class I – 2.3%, Class II – 8.8%, Class III – 16.0%, Class IV
– 45.0% and Class V – 27.9%. The mortality in each class in our
series was similar to the mortality in the PSI study except for Class
II (death of a patient with a severe co-morbid condition).
Conclusions: The PSI-based model performed well when applied
to our population. Most of the low risk-classes (I-III) patients could
have been safely treated as outpatients.
Downloads
References
Froes F. Pneumonia da comunidade no adulto em Portugal continental – incidência e mortalidade dos internamentos hospitalares nos anos de 1998 a 2000. Rev Port Pneumol 2003;IX(3):187-194.
Lim WS, Macfarlane JT, Boswell TC et al. Study of community acquired pneumonia aetiology (SCAPA) in adults admitted to hospital: implications for management guidelines. Thorax 2001;56: 296-301.
Lim WS, van der Eerden MM, Laing R et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 2003;58: 377-382.
Fine MJ, Auble TE, Yealy DM et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med 1997;336:
-250.
Aujesky D, Auble TE, Yealy DM et al. Prospective comparison of three validated prediction rules for prognosis in community-acquired pneumonia. Am J Med 2005;118: 384-392.
Barlett JG, Dowell SF, Mandell LA et al. Practice guidelines for the management of community-acquired pneumonia in adults. Infectious Diseases Society of America. Clin Infect Dis 2000;31: 347-382.
Mandell LA, Barlett JG, Dowell SF et al. Update of practice guidelines for the management of community-acquired pneumonia in immunocompetent adults. Clin Infect Dis 2003;37: 1405-1033.
British Thoracic Society Standards of Care Committee. BTS guidelines for the management of community acquired pneumonia in adults. Thorax 2001;56(suppl 4):IV1-64
Recomendações de abordagem diagnostica e terapêutica da pneumonia da comunidade em adultos imunocompetentes. Sociedade Portuguesa de Pneumologia. Rev Port Pneumol 2003 IX (5): 435-461.
Falguera M, Martín M, Ruiz-González A, Pifarré R, García M. Community-acquired pneumonia as the initial manifestation of serious underlying diseases. Am J Med 2005;118: 378-383.
American Thoracic Society. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005;171: 388-416.
Shefet D, Robenshtok E, Paul M, Leibovici, L. Empirical atypical coverage for inpatients with community-acquired pneumonia. Systematic review of randomized controlled trials. Arch Intern Med 2005;165: 1992-2000.
Glerant JC, Hellmuth D, Schmit JL et al. Utility of blood cultures in community-acquired pneumonia requiring hospitalization: influence of antibiotic treatment before admission. Resp Medicine 1999;93: 208-212.
Reimer LG, Carroll KC. Role of the microbiology laboratory in the diagnosis of lower respiratory tract infections. Clin Infect Dis 1998;26(3): 742-748.
Plouffe JF, McNally C, File TM Jr. Value of non-invasive studies in community-acquired pneumonia. Infec Dis Clin North Am 1998;12(3): 689-699.
Kalin M, Ortvist A, Almela M, et al. Prospective study of prognostic factors in community-acquired bacteremic pneumococcal disease in 5 countries. J Inf Dis 2000;182: 840-847.
Nuorti JC, Farley MM, Harrison LH et al. Cigarette smoking and invasive pneumococcal disease. N Eng J Med 2000;342: 681-689.
Rhew DC. Quality indicators for the management of pneumonia in vulnerable elders. Annals Int Med 2001;135: 736-743.
Aujesky D, Stone RA, Obrosky DS et al. Using randomized controlled trial data, the agreement between retrospectively and prospectively collected data comprising the pneumonia severity index was substantial. J Clin Epidemiol 2005;58: 357-363
Additional Files
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2023 Medicina Interna
Open Access
