The ventilator-associated pneumonia PIRO score: a tool for predicting ICU mortality and health-care resources use in ventilator-associated pneumonia.
BACKGROUND
No score is available to assess severity and stratify mortality risk in ventilator-associated pneumonia (VAP). Our objective was to develop a severity assessment tool for VAP patients.


METHODS
A prospective, observational, cohort study was performed including 441 patients with VAP in three multidisciplinary ICUs. Multivariate logistic regression was performed to identify variables independently associated with ICU mortality. Results were converted into a four-variable score based on the PIRO (predisposition, insult, response, organ dysfunction) concept for ICU mortality risk stratification in VAP patients.


RESULTS
Comorbidities (COPD, immunocompromise, heart failure, cirrhosis, or chronic renal failure); bacteremia; systolic BP < 90 mm Hg; and ARDS. A simple, four-variable VAP PIRO score was obtained at VAP onset. Mortality varied significantly according to VAP PIRO score (p < 0.001). On the basis of observed mortality for each VAP PIRO score, patients were stratified into three levels of risk: (1) mild, 0 to 1 points; (2) high, 2 points; (3) very high, 3 to 4 points. VAP PIRO score was associated with higher risk of death in Cox regression analysis in the high-risk group (hazard ratio, 2.14; 95% confidence interval [CI], 1.19 to 3.86) and the very-high-risk group (hazard ratio, 4.63; 95% confidence interval, 2.68 to 7.99). Moreover, medical resource use after VAP diagnosis was higher in high-risk and very-high-risk levels compared to patients at mild risk, evaluated using length of ICU stay (mean +/- SD, 22.0 +/- 10.6 d vs 18.7 +/- 12.8 d, p < 0.05) and duration of mechanical ventilation (18.3 +/- 10.1 d vs 15.1 +/- 11.5 d, p < 0.05).


CONCLUSIONS
VAP PIRO score is a simple, practical clinical tool for predicting ICU mortality and health-care resources use that is likely to assist clinicians in determining VAP severity.
Lisboa
Thiago
T
Critical Care Department, Joan XXIII University Hospital, University Rovira & Virgili, Institut Pere Virgili, CIBER Enfermedades Respiratorias, Tarragona, Spain.
Diaz
Emili
E
Critical Care Department, Joan XXIII University Hospital, University Rovira & Virgili, Institut Pere Virgili, CIBER Enfermedades Respiratorias, Tarragona, Spain.
Sa-Borges
Marcio
M
Intensive Care Unit, Hospital Son Llatzer, Palma de Mallorca, Spain.
Socias
Antonia
A
Intensive Care Unit, Hospital Son Llatzer, Palma de Mallorca, Spain.
Sole-Violan
Jordi
J
Critical Care Department, Dr. Negrin Hospital, Gran Canaria, Spain.
Rodríguez
Alejandro
A
Critical Care Department, Joan XXIII University Hospital, University Rovira & Virgili, Institut Pere Virgili, CIBER Enfermedades Respiratorias, Tarragona, Spain.
Rello
Jordi
J
Critical Care Department, Joan XXIII University Hospital, University Rovira & Virgili, Institut Pere Virgili, CIBER Enfermedades Respiratorias, Tarragona, Spain; Critical Care Department, Joan XXIII University Hospital, University Rovira & Virgili, Institut Pere Virgili, CIBER Enfermedades Respiratorias, Tarragona, Spain. Electronic address: jrello.hj23.ics@gencat.cat.
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003422:Critical Care; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000401:mortality* / Q000628:therapy*; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012720:Severity of Illness Index