title: Improving the 2007 Infectious Disease Society of America/American Thoracic Society severe community-acquired pneumonia criteria to predict intensive care unit admission.
abstract: OBJECTIVE
  To improve 2007 Infectious Disease Society of America/American Thoracic Society (IDSA/ATS) severity criteria to predict intensive care unit (ICU) admission in patients hospitalized with pneumonia.
  
  
  METHODS
  A composite score that included the 2007 IDSA/ATS criteria for severe pneumonia and additional significant variables identified by recent publications was tested in patients hospitalized with community-acquired pneumonia.
  
  
  RESULTS
  Among 787 patients hospitalized with community-acquired pneumonia, 156 (19.8%) required admission to the ICU. We identified one major criterion (arterial pH <7.30), and 4 minor criteria (tachycardia >125 bpm, arterial pH 7.30-7.34, sodium <130 mEq/L and glucose >250 mg/dL) to be associated with ICU admission. Adding arterial pH <7.30 to the 2 2007 IDSA/ATS major criteria increased sensitivity from 61.5% to 71.8% and area under the curve (AUC) from 0.80 to 0.86. Adding in sequence the four minor criteria to the 2007 IDSA/ATS minor criteria, increased sensitivity from 41.7% to 53.8%, and AUC from 0.65 to 0.69. In the new composite score, combining 1 of 3 major criteria with 3 of 12 minor criteria showed a sensitivity of 92.9% and an AUC of 0.88.
  
  
  CONCLUSIONS
  The addition of arterial pH <7.30 to the 2007 IDSA/ATS major criteria improves sensitivity and AUC to identify patients who will require ICU care.
authors.affiliation: University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
authors.forename: Oriol
authors.initials: O
authors.lastname: Sibila
authors.forename: G Umberto
authors.initials: GU
authors.lastname: Meduri
authors.forename: Eric M
authors.initials: EM
authors.lastname: Mortensen
authors.forename: Antonio
authors.initials: A
authors.lastname: Anzueto
authors.forename: Elena
authors.initials: E
authors.lastname: Laserna
authors.forename: Juan F
authors.initials: JF
authors.lastname: Fernandez
authors.forename: Ali
authors.initials: A
authors.lastname: El-Sohl
authors.forename: Marcos I
authors.initials: MI
authors.lastname: Restrepo
mesh_terms: D019540:Area Under Curve; D016009:Chi-Square Distribution; D017714:Community-Acquired Infections / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D011014:Pneumonia / Q000453:epidemiology*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology