Predicting death in patients hospitalized for community-acquired pneumonia.
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.


METHODS
Historical cohort study.


METHODS
University hospital.


METHODS
Adults admitted to the hospital for community-acquired pneumonia.


METHODS
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.


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%.


CONCLUSIONS
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.
Farr
B M
BM
University of Virginia Health Sciences Center, Charlottesville.
Sloman
A J
AJ
Fisch
M J
MJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001794:Blood Pressure; D001806:Blood Urea Nitrogen; D006760:Hospitalization; D006801:Humans; D008875:Middle Aged; D011014:Pneumonia / Q000097:blood / Q000188:drug therapy / Q000401:mortality* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011379:Prognosis; D012044:Regression Analysis; D012119:Respiration; D012189:Retrospective Studies; D016019:Survival Analysis; D014768:Virginia
D000900:Anti-Bacterial Agents