title: Mortality among severe community-acquired pneumonia patients depends on combinations of 2007 IDSA/ATS minor criteria.
abstract: OBJECTIVE
  The individual 2007 Infectious Disease Society of America (IDSA)/American Thoracic Society (ATS) minor criteria for severe community-acquired pneumonia (CAP) are of unequal weight in predicting mortality. It is not clear whether the combinations of predictive findings might imply diverse severities or different mortalities.
  
  
  METHODS
  A prospective two centre cohort study was performed of 385 severe CAP patients fulfilling three or more IDSA/ATS minor criteria amongst 1430 patients.
  
  
  RESULTS
  Hospital mortality rose sharply from 5.7%, 9.9%, and 16.5%, respectively, for patients with none of three predictive findings most strongly associated to mortality (PaO2/FiO2 ≤ 250mm Hg, confusion and uraemia), one of those, and two of those to 38.6% for patients with all those (p<0.001). The number of three predictive findings present had a significantly increased odds ratio for mortality of 2.796 (p<0.001), and had the degree of positive association with sequential organ failure assessment scores at 72hours, incurring significantly longer hospital stay and higher costs.
  
  
  CONCLUSIONS
  Different combinations of 2007 IDSA/ATS minor criteria for severe CAP were associated to diverse severities and different mortalities. The combination of PaO2/FiO2 ≤ 250mm Hg, confusion and uraemia predicted more severity and higher mortality compared with others.
authors.affiliation: Department of Primary Care, Affiliated Futian Hospital, Guangdong Medical College, Shenzhen, Guangdong, China, 518033.
authors.forename: Hai-yan
authors.initials: HY
authors.lastname: Li
authors.affiliation: Department of Respiratory Medicine, Affiliated Futian Hospital, Guangdong Medical College, Shenzhen, Guangdong, China, 518033. Electronic address: qiguo88@hotmail.com.
authors.forename: Qi
authors.initials: Q
authors.lastname: Guo
authors.affiliation: Department of Respiratory Medicine, Affiliated Shenzhen Hospital, Peking University, Shenzhen, Guangdong, China, 518036.
authors.forename: Wei-dong
authors.initials: WD
authors.lastname: Song
authors.affiliation: Department of Respiratory Medicine, Affiliated Futian Hospital, Guangdong Medical College, Shenzhen, Guangdong, China, 518033.
authors.forename: Yi-ping
authors.initials: YP
authors.lastname: Zhou
authors.affiliation: Department of Respiratory Medicine, Affiliated Futian Hospital, Guangdong Medical College, Shenzhen, Guangdong, China, 518033.
authors.forename: Ming
authors.initials: M
authors.lastname: Li
authors.affiliation: Department of Respiratory Medicine, Affiliated Futian Hospital, Guangdong Medical College, Shenzhen, Guangdong, China, 518033.
authors.forename: Xiao-ke
authors.initials: XK
authors.lastname: Chen
authors.affiliation: Department of Respiratory Medicine, Affiliated Futian Hospital, Guangdong Medical College, Shenzhen, Guangdong, China, 518033.
authors.forename: Hui
authors.initials: H
authors.lastname: Liu
authors.affiliation: Department of Respiratory Medicine, Affiliated Futian Hospital, Guangdong Medical College, Shenzhen, Guangdong, China, 518033.
authors.forename: Hong-lin
authors.initials: HL
authors.lastname: Peng
authors.affiliation: Department of Respiratory Medicine, Affiliated Futian Hospital, Guangdong Medical College, Shenzhen, Guangdong, China, 518033.
authors.forename: Hai-qiong
authors.initials: HQ
authors.lastname: Yu
authors.affiliation: Department of Respiratory Medicine, Affiliated Futian Hospital, Guangdong Medical College, Shenzhen, Guangdong, China, 518033.
authors.forename: Xia
authors.initials: X
authors.lastname: Chen
authors.affiliation: Department of Respiratory Medicine, Affiliated Futian Hospital, Guangdong Medical College, Shenzhen, Guangdong, China, 518033.
authors.forename: Nian
authors.initials: N
authors.lastname: Liu
authors.affiliation: Department of Respiratory Medicine, Affiliated Shenzhen Hospital, Peking University, Shenzhen, Guangdong, China, 518036.
authors.forename: Zhong-dong
authors.initials: ZD
authors.lastname: Lü
authors.affiliation: Department of Radiology, Affiliated Futian Hospital, Guangdong Medical College, Shenzhen, Guangdong, China, 518033.
authors.forename: Li-hua
authors.initials: LH
authors.lastname: Liang
authors.affiliation: Department of Radiology, Affiliated Futian Hospital, Guangdong Medical College, Shenzhen, Guangdong, China, 518033.
authors.forename: Qing-zhou
authors.initials: QZ
authors.lastname: Zhao
authors.affiliation: Guangzhou Institute of Respiratory Diseases (State Key Laboratory of Respiratory Diseases), First Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China, 510120.
authors.forename: Mei
authors.initials: M
authors.lastname: Jiang
mesh_terms: D000368:Aged; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000401:mortality*; D011446:Prospective Studies; D012720:Severity of Illness Index
keywords: Combination; Minor criteria; Mortality; Severe community-acquired pneumonia