title: Severity assessment tools in ICU patients with 2009 influenza A (H1N1) pneumonia.
abstract: The aim of this study was to determine if severity assessment tools (general severity of illness and community-acquired pneumonia specific scores) can be used to guide decisions for patients admitted to the intensive care unit (ICU) due to pandemic influenza A pneumonia. A prospective, observational, multicentre study included 265 patients with a mean age of 42 (±16.1) years and an ICU mortality of 31.7%. On admission to the ICU, the mean pneumonia severity index (PSI) score was 103.2 ± 43.2 points, the CURB-65 score was 1.7 ± 1.1 points and the PIRO-CAP score was 3.2 ± 1.5 points. None of the scores had a good predictive ability: area under the ROC for PSI, 0.72 (95% CI, 0.65-0.78); CURB-65, 0.67 (95% CI, 0.59-0.74); and PIRO-CAP, 0.64 (95% CI, 0.56-0.71). The PSI score (OR, 1.022 (1.009-1.034), p 0.001) was independently associated with ICU mortality; however, none of the three scores, when used at ICU admission, were able to reliably detect a low-risk group of patients. Low risk for mortality was identified in 27.5% of patients using PIRO-CAP, but above 40% when using PSI (I-III) or CURB65 (<2). Observed mortality was 13.7%, 13.5% and 19.4%, respectively. Pneumonia-specific scores undervalued severity and should not be used as instruments to guide decisions in the ICU.
authors.affiliation: Intensive Care Department, Hospital S. João EPE, Faculdade de Medicina do Porto, Porto, Portugal. jmcrpereira@yahoo.com
authors.forename: J M
authors.initials: JM
authors.lastname: Pereira
authors.forename: R P
authors.initials: RP
authors.lastname: Moreno
authors.forename: R
authors.initials: R
authors.lastname: Matos
authors.forename: A
authors.initials: A
authors.lastname: Rhodes
authors.forename: I
authors.initials: I
authors.lastname: Martin-Loeches
authors.forename: M
authors.initials: M
authors.lastname: Cecconi
authors.forename: T
authors.initials: T
authors.lastname: Lisboa
authors.forename: J
authors.initials: J
authors.lastname: Rello
mesh_terms: D000328:Adult; D000368:Aged; D001118:Argentina / Q000453:epidemiology; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000302:isolation & purification*; D007251:Influenza, Human / Q000453:epidemiology* / Q000821:virology; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011024:Pneumonia, Viral / Q000453:epidemiology* / Q000821:virology; D011446:Prospective Studies; D012372:ROC Curve; D012720:Severity of Illness Index