title: Repeated pneumonia severity index measurement after admission increases its predictive value for mortality in severe community-acquired pneumonia.
abstract: OBJECTIVE
  Severe community-acquired pneumonia (CAP) is associated with high hospital mortality, and accurate assessment of patients is important for supporting clinical decision making. The Pneumonia Severity Index (PSI) is a good tool for predicting disease severity, especially in the low-risk group of patients with CAP. We investigated whether the change in PSI measurement after admission could identify patients at high risk of mortality from CAP.
  
  
  METHODS
  We prospectively studied 250 inpatients with CAP. PSI was measured at admission and 72 hours later at a tertiary referral medical center from May 2005 to February 2006. The initial and repeated PSI results were compared. Hospital mortality was used as the outcome measure.
  
  
  RESULTS
  Initial PSI in high-risk patients (PSI class > IV) had a low specificity (37%), and a low positive predictive value (PPV) (17%). Increased repeated PSI score, as compared with initial score, was associated with an increased mortality rate (from 7.8% to 33.3% in class IV, and 25.3% to 53.3% in class V; p < 0.0001), and improved the predictive value, with 94% specificity and a PPV of 46% for mortality in high-risk patients.
  
  
  CONCLUSIONS
  Increased PSI score, 72 hours after admission, for patients with CAP improved the predictive value of PSI score and more accurately identified patients with a high risk of mortality.
authors.affiliation: Department of Internal Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Chiung-Zuei
authors.initials: CZ
authors.lastname: Chen
authors.forename: Po-Sheng
authors.initials: PS
authors.lastname: Fan
authors.forename: Chien-Chung
authors.initials: CC
authors.lastname: Lin
authors.forename: Cheng-Hung
authors.initials: CH
authors.lastname: Lee
authors.forename: Tzuen-Ren
authors.initials: TR
authors.lastname: Hsiue
mesh_terms: D017714:Community-Acquired Infections / Q000175:diagnosis / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D011014:Pneumonia / Q000175:diagnosis / Q000401:mortality*; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors