title: Prediction of mortality in community-acquired pneumonia in hospitalized patients.
abstract: BACKGROUND
  Community-acquired pneumonia (CAP) is common and associated with a significant mortality. Currently recommended criteria to assess severity of CAP could be improved.
  
  
  METHODS
  We derived 2 new criteria CARSI [confusion, age (<65, ≥65 to <85 or≥ 85), respiratory rate and shock index] and CARASI, where shock index is replaced by temperature-adjusted shock index based on previous observations. By using data of a prospective study performed in Norfolk and Suffolk, United Kingdom, we compare these new indices with the CURB-65 criteria.
  
  
  RESULTS
  A total of 190 patients were included (men, 53%). The age range was 18 to 101 years (median, 76 years). There were a total of 54 deaths during a 6-week follow-up, all within 30 days of admission. Sixty-five (34%) had severe pneumonia by CURB-65. Using CARSI and CARASI, 39 (21%) and 36 (19%) had severe pneumonia, respectively. Sensitivity was slightly less, but specificity was higher with CARSI and CARASI indices than that of CURB-65. Positive and negative predictive values in predicting death during 6-week follow-up were comparable among 3 indices examined. The receiver operating characteristic curve values (95% confidence interval) for the criteria were 0.67 (0.60-0.75) for CURB-65, 0.64 (0.60-0.71) for CARSI and 0.64 (0.57-0.71) for CARASI. Comparing receiver operating characteristic curves for CURB-65 versus CARSI, or CURB-65 versus CARASI, there was no evidence of a difference between the tools, P = 0.35 and 0.33, respectively. There was good agreement, which was strongly statistically significant (kappa = 0.56, P < 0.0001 and kappa = 0.54, P < 0.0001, respectively).
  
  
  CONCLUSIONS
  Both CARSI and CARASI are useful in predicting deaths associated with CAP, including older patients, and may be particularly useful in the emergency and community settings.
authors.affiliation: Norwich Medical School, Faculty of Medicine and Health Sciences, United Kingdom.
authors.forename: Patrick
authors.initials: P
authors.lastname: Musonda
authors.forename: Prasanna
authors.initials: P
authors.lastname: Sankaran
authors.forename: Deepak N
authors.initials: DN
authors.lastname: Subramanian
authors.forename: Alexandra C
authors.initials: AC
authors.lastname: Smith
authors.forename: Philippa
authors.initials: P
authors.lastname: Prentice
authors.forename: Syed M
authors.initials: SM
authors.lastname: Tariq
authors.forename: Ajay V
authors.initials: AV
authors.lastname: Kamath
authors.forename: Phyo K
authors.initials: PK
authors.lastname: Myint
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D001831:Body Temperature; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000175:diagnosis* / Q000401:mortality*; D004739:England; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000175:diagnosis* / Q000401:mortality*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012769:Shock / Q000175:diagnosis; D018709:Statistics, Nonparametric; D055815:Young Adult