A predictive model for the management of community-acquired pneumonia.
BACKGROUND
Understanding what determines the prognosis of community-acquired pneumonia (CAP) is especially important for decisions on hospitalization and antimicrobial therapy. The objective of the present study was to compare the predictability of mortality in our patients to that of the pneumonia patient outcomes research team (PORT) study.


METHODS
Data of 320 patients admitted with CAP were retrospectively evaluated and classified according to the published scheme.


RESULTS
One-month mortality was 14.4%; 1-year mortality was 27.8%, two-thirds from new episodes. Univariate logistic regression risk factors for the 1-month mortality rate included leukocytosis, anemia, hypoalbuminemia, elevated blood urea nitrogen, >or= two comorbidities, tachycardia, tachypnea, acidosis, stupor, age > 65 years and high serum lactic dehydrogenase. These variables, except the last two, plus pleural effusion and bilateral infiltration were also risk factors for 1-year mortality. In the multivariate models, eight of these factors were significant risk factors, four for 1-month mortality and six for 1-year mortality. Our model for prediction of 1-month mortality had a sensitivity of 65%, specificity of 95% and accuracy of 91%.


CONCLUSIONS
Agreement between predictions by our model and the published model was considerable, showing that most patients in the low score groups should not have been hospitalized.
Raz
R
R
Infectious Diseases unit, Ha'Emek Medical Cener, Afula 18101, Afula, Israel. raz_r@clalit.org.il
Dyachenko
P
P
Levy
Y
Y
Flatau
E
E
Reichman
N
N
D000293:Adolescent; D000328:Adult; D000368:Aged; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000401:mortality*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011014:Pneumonia / Q000453:epidemiology / Q000401:mortality*; D011237:Predictive Value of Tests; D012307:Risk Factors; D012680:Sensitivity and Specificity