Community-acquired bacterial pneumonia in human immunodeficiency virus-infected patients: validation of severity criteria. The Grupo Andaluz para el Estudio de las Enfermedades Infecciosas.
Severity criteria for community-acquired pneumonia (CAP) have always excluded patients with human immunodeficiency virus (HIV) infection. A 1-yr, multicenter, prospective observational study of HIV-infected patients with bacterial CAP was done to validate the criteria used in the American Thoracic Society (ATS) guidelines for CAP, and to determine the prognosis-associated factors in the HIV-infected population with bacterial CAP. Overall, 355 cases were included, with an attributable mortality of 9.3%. Patients who met the ATS criteria had a longer hospital stay (p = 0.01), longer duration of fever (p < 0.001), and higher attributable mortality (13.1% versus 3.5%, p = 0.02) than those who did not. Three factors were independently related to mortality: CD4(+) cell count < 100/microl, radiologic progression of disease, and shock. Pleural effusion, cavities, and/or multilobar infiltrates at admission were independently associated with radiologic progression. A prognostic rule based on the five criteria of shock, CD4(+) cell count < 100/microl, pleural effusion, cavities, and multilobar infiltrates had a high negative predictive value for mortality (97.1%). The attributable mortality for severe pneumonia was 11.3%, as compared with 1.3% for nonsevere disease (p = 0.008). The ATS severity criteria are valid in HIV-infected patients with bacterial CAP. Our study provides the basis for identification of patients who may require hospitalization determined by clinical judgment and the five clinical criteria of shock, a CD4(+) cell count < 100/microl, pleural effusion, cavities, and multilobar involvement. These prognostic factors should be validated in independent cohort studies.
Cordero
E
E
Infectious Diseases Services, Virgen del Rocío University Hospital, Seville, Spain. mcordero@cica.es
Pachón
J
J
Rivero
A
A
Girón
J A
JA
Gómez-Mateos
J
J
Merino
M D
MD
Torres-Tortosa
M
M
González-Serrano
M
M
Aliaga
L
L
Collado
A
A
Hernández-Quero
J
J
Barrera
A
A
Nuño
E
E
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000382:microbiology / Q000401:mortality; D000328:Adult; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality; D005260:Female; D015497:HIV-1; D006801:Humans; D016015:Logistic Models; D008297:Male; D018410:Pneumonia, Bacterial / Q000175:diagnosis* / Q000382:microbiology / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013030:Spain