title: Evaluation of the IDSA/ATS minor criteria for severe community-acquired pneumonia.
abstract: BACKGROUND
  Our aim was to evaluate the minor criteria recommended by the 2007 Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) as predictors of 30-day mortality, the need for invasive mechanical ventilation, and/or the need for vasopressor support as markers of severity in patients hospitalized with community-acquired pneumonia (CAP).
  
  
  METHODS
  Patients admitted to 2 academic teaching hospitals over a 4-year period (January 1, 1999 to December 1, 2002) were identified as having CAP. We used modified minor criteria established by the 2007 IDSA/ATS guidelines. The primary outcome measure was 30-day mortality, and the secondary outcome measures were need for invasive mechanical ventilation and/or need for vasopressor support.
  
  
  RESULTS
  About half of the patients in the cohort (n = 352/787 [46%]) had ≥ 1 minor criterion, but only 128 (16.3%) had ≥ 3 minor criteria present at hospital admission. In the multivariable analysis, hypoxemia, multilobar infiltrates, and leukopenia were associated with 30-day mortality (P < 0.05). In addition, hypoxemia and confusion/disorientation were associated with the need for invasive mechanical ventilation and/or vasopressor support (P < 0.05). The presence of ≥ 3 minor criteria was associated with 30-day mortality (odds ratio, 4.82), and the need for invasive mechanical ventilation and/or vasopressor support (odds ratio, 2.59).
  
  
  CONCLUSIONS
  Our results show that hypoxemia, multilobar infiltrates, and leukopenia were the most predictive minor criteria for 30-day mortality. In contrast, hypoxemia and confusion/disorientation were the 2 individual minor severe criteria that were more likely to require invasive mechanical ventilation and/or vasopressor support. At least 3 2007 IDSA/ATS minor severe criteria were associated with 30-day mortality and need for invasive mechanical ventilation and/or vasopressor support.
authors.affiliation: University of Texas Health Science Center at San Antonio, San Antonio, TX; Servei de Pneumologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Oriol
authors.initials: O
authors.lastname: Sibila
authors.forename: Eric M
authors.initials: EM
authors.lastname: Mortensen
authors.forename: Grant
authors.initials: G
authors.lastname: Redrow
authors.forename: Esmeralda
authors.initials: E
authors.lastname: Lugo
authors.forename: Elena
authors.initials: E
authors.lastname: Laserna
authors.forename: Antonio
authors.initials: A
authors.lastname: Anzueto
authors.forename: Marcos I
authors.initials: MI
authors.lastname: Restrepo
mesh_terms: D017714:Community-Acquired Infections / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D011014:Pneumonia / Q000401:mortality*; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012955:Societies, Medical; D013781:Texas; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D014662:Vasoconstrictor Agents