title: Modified IDSA/ATS Minor Criteria for Severe Community-Acquired Pneumonia Best Predicted Mortality.
abstract: It is not clear whether the IDSA/ATS minor criteria for severe community-acquired pneumonia (CAP) could be simplified or even be modified to orchestrate improvements in predicting mortality.A retrospective cohort study of 1230 CAP patients was performed to simplify and to modify the scoring system by excluding 4 noncontributory or infrequent variables (leukopenia, hypothermia, hypotension, and thrombocytopenia) and by excluding these variables and then adding age ≥65 years, respectively. The simplification and modification were tested against a prospective 2-center validation cohort of 1409 adults with CAP.The increasing numbers of IDSA/ATS, simplified, and modified minor criteria present in the retrospective cohort were positively associated with the mortality, showing significant increased odds ratios for mortality of 2.711, 4.095, and 3.755, respectively. The validation cohort confirmed a similar pattern. The sensitivity, specificity, positive predictive value, and Youden index of modified minor criteria for mortality prediction were the best pattern in the retrospective cohort. High values of corresponding indices were confirmed in the validation cohort. The highest accuracy of the modified version for predicting mortality in the retrospective cohort was illustrated by the highest area under the receiver operating characteristic curve of 0.925 (descending order: modified, simplified, and IDSA/ATS minor criteria). The validation cohort confirmed a similar paradigm.The IDSA/ATS minor criteria could be simplified to 5 variables and then be modified to orchestrate improvements in predicting mortality in CAP patients. The modified version best predicted mortality. These were more suitable for clinic and emergency department.
authors.affiliation: From the Department of Primary Care, Affiliated Futian Hospital, Guangdong Medical College (HYL); Department of Respiratory Medicine, Affiliated Futian Hospital, Guangdong Medical College (QG, YPZ, ML, XKC, HL, HLP, HQY, XC, NL); Department of Respiratory Medicine, Affiliated Shenzhen Hospital, Peking University (WDS, ZDL); Department of Radiology, Affiliated Futian Hospital, Guangdong Medical College, Shenzhen (LHL, QZZ); and Guangzhou Institute of Respiratory Diseases (State Key Laboratory of Respiratory Diseases), First Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China(MJ).
authors.forename: Hai-Yan
authors.initials: HY
authors.lastname: Li
authors.forename: Qi
authors.initials: Q
authors.lastname: Guo
authors.forename: Wei-Dong
authors.initials: WD
authors.lastname: Song
authors.forename: Yi-Ping
authors.initials: YP
authors.lastname: Zhou
authors.forename: Ming
authors.initials: M
authors.lastname: Li
authors.forename: Xiao-Ke
authors.initials: XK
authors.lastname: Chen
authors.forename: Hui
authors.initials: H
authors.lastname: Liu
authors.forename: Hong-Lin
authors.initials: HL
authors.lastname: Peng
authors.forename: Hai-Qiong
authors.initials: HQ
authors.lastname: Yu
authors.forename: Xia
authors.initials: X
authors.lastname: Chen
authors.forename: Nian
authors.initials: N
authors.lastname: Liu
authors.forename: Zhong-Dong
authors.initials: ZD
authors.lastname: Lü
authors.forename: Li-Hua
authors.initials: LH
authors.lastname: Liang
authors.forename: Qing-Zhou
authors.initials: QZ
authors.lastname: Zhao
authors.forename: Mei
authors.initials: M
authors.lastname: Jiang
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D005260:Female; D006801:Humans; D007022:Hypotension / Q000209:etiology; D007035:Hypothermia / Q000209:etiology; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D010343:Patient Admission / Q000592:standards; D011014:Pneumonia / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D011237:Predictive Value of Tests; D011379:Prognosis; D011859:Radiography; D012107:Research Design; D056152:Respiratory Rate; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013921:Thrombocytopenia / Q000209:etiology