Community-acquired pneumonia: Objective criteria to predict severe disease

The authors examined the medical records of all adult CAP patients admitted to a non-academic, community health-system from November 1999 to April 2000. All patients admitted to the ICU were defined as having severe disease. Of the 782 patients evaluated, 133 (17%) had severe CAP. Severe patients had higher PSI scores (122±k39 vs. 100±39, P < 0.0001), mortality rates (21% vs. 5%, P < 0.0001), total hospital costs ($10,073 vs. $3,537, P < 0.0001), and longer lengths of stay (10.6±7.4 2vs. 5.4±4.0 days, P < 0.0001) than non-severe patients. In multivariate analysis, only systolic blood pressure < 90 mm Hg (P = 0.0004), pH < 7.35 (P < 0.0001), oxygen saturation < 90% (P < 0.0001), and pulse > 125 beats/min (P < 0.0001) predicted severe CAP. Inclusion of 3 or more of these variables resulted in a sensitivity, specificity, positive predictive value, and negative predictive value of 83%, 84%, 52%, and 96%.