title: A Clinical Predictor Score for 30-Day Mortality among HIV-Infected Adults Hospitalized with Pneumonia in Uganda.
abstract: BACKGROUND
  Pneumonia is a major cause of mortality among HIV-infected patients. Pneumonia severity scores are promising tools to assist clinicians in predicting patients' 30-day mortality, but existing scores were developed in populations infected with neither HIV nor tuberculosis (TB) and include laboratory data that may not be available in resource-limited settings. The objective of this study was to develop a score to predict mortality in HIV-infected adults with pneumonia in TB-endemic, resource-limited settings.
  
  
  METHODS
  We conducted a secondary analysis of data from a prospective study enrolling HIV-infected adults with cough ≥2 weeks and <6 months and clinically suspected pneumonia admitted to Mulago Hospital in Kampala, Uganda from September 2008 to March 2011. Patients provided two sputum specimens for mycobacteria, and those with Ziehl-Neelsen sputum smears that were negative for mycobacteria underwent bronchoscopy with inspection for Kaposi sarcoma and testing for mycobacteria and fungi, including Pneumocystis jirovecii. A multivariable best subsets regression model was developed, and one point was assigned to each variable in the model to develop a clinical predictor score for 30-day mortality.
  
  
  RESULTS
  Overall, 835 patients were studied (mean age 34 years, 53.4% female, 30-day mortality 18.2%). A four-point clinical predictor score was identified and included heart rate >120 beats/minute, respiratory rate >30 breaths/minute, oxygen saturation <90%, and CD4 cell count <50 cells/mm3. Patients' 30-day mortality, stratified by score, was: score 0 or 1, 12.6%, score 2 or 3, 23.4%, score 4, 53.9%. For each 1 point change in clinical predictor score, the odds of 30-day mortality increased by 65% (OR 1.65, 95% CI 1.39-1.96, p <0.001).
  
  
  CONCLUSIONS
  A simple, four-point scoring system can stratify patients by levels of risk for mortality. Rapid identification of higher risk patients combined with provision of timely and appropriate treatment may improve clinical outcomes. This predictor score should be validated in other resource-limited settings.
authors.affiliation: Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America.
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Koss
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Leah G
authors.initials: LG
authors.lastname: Jarlsberg
authors.affiliation: Makerere University-University of California San Francisco Research Collaboration, Kampala, Uganda.
authors.forename: Saskia
authors.initials: S
authors.lastname: den Boon
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America; Makerere University-University of California San Francisco Research Collaboration, Kampala, Uganda.
authors.forename: Adithya
authors.initials: A
authors.lastname: Cattamanchi
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America; Makerere University-University of California San Francisco Research Collaboration, Kampala, Uganda.
authors.forename: J Lucian
authors.initials: JL
authors.lastname: Davis
authors.affiliation: Makerere University-University of California San Francisco Research Collaboration, Kampala, Uganda; Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Department of Medicine, Mulago National Referral and Teaching Hospital, Kampala, Uganda.
authors.forename: William
authors.initials: W
authors.lastname: Worodria
authors.affiliation: Makerere University-University of California San Francisco Research Collaboration, Kampala, Uganda.
authors.forename: Irene
authors.initials: I
authors.lastname: Ayakaka
authors.affiliation: Makerere University-University of California San Francisco Research Collaboration, Kampala, Uganda.
authors.forename: Ingvar
authors.initials: I
authors.lastname: Sanyu
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America; Makerere University-University of California San Francisco Research Collaboration, Kampala, Uganda; HIV/AIDS Division, Department of Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Laurence
authors.initials: L
authors.lastname: Huang
mesh_terms: D000328:Adult; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000401:mortality*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000401:mortality*; D011446:Prospective Studies; D014454:Uganda