Community acquired pneumonia and pneumonia severity index 20 (PSI-20): a retrospective study of the patients admitted to an internal medicine service, between 2007 and 2008
DOI:
https://doi.org/10.24950/rspmi.989Keywords:
community acquired pneumonia, pneumonia severity Index 20 (PSI-20)Abstract
Introduction: The precise incidence of Community Acquired Pneumonia (CAP) in Portugal is unknown, being estimated in 50 000
to 100 000 cases per year, with a tendency to increase annually.
Some criteria have been developed to predict the prognosis in
CAP patients to help the physician decision where to treat the
patient (outpatient versus inpatient), including the Pneumonia
Severity Index 20 (PSI-20).
Objectives: Assessing applicability of the PSI-20 risk classes,
the indication for inpatient treatment in our population, demographic features and other factors influencing mortality.
Methods: Retrospective study based on hospitalized patients´
clinical records assessment with CAP for two years in an Internal
Medicine Service. Assessment of the PSI twenty variables and
stratification of patients into risk classes I to V was performed.
Results: we assessed 582 patients, 55% were male and 45%
female, with an average age of 74.1 years old (± 14.9years).
Mortality was similar in both genders and increased with age.
Mortality was higher in patients coming from nursing homes,
but was similar when comparing co-morbidities. The distribution
among risk classes was: class I – 3.5%, class II – 4.2%, class
III – 6.0%, class IV – 28.5% e class V – 57.7%. In our series,
mortality was similar to the one predicted by the PSI-20. Initial
antibiotic therapy was empirical.
Conclusion: The algorithm to identify low-risk patients is applicable to our population. Based on the recommendations for
inpatient treatment, most of the patients in risk class I, II and III
could have been treated in an outpatient regimen. Mortality was
higher among classes IV and V, as in the study by Fine et al. and subsequent validations.
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