title: A mortality prediction rule for non-elderly patients with community-acquired pneumonia.
abstract: BACKGROUND
  No mortality prediction rule is suited for non-elderly patients with community-acquired pneumonia. Therefore, we tried to create a mortality prediction rule that is simple and suitable for non-elderly patients with community-acquired pneumonia.
  
  
  METHODS
  Because of low mortality at young age, we used information from an administrative database that included A-DROP data. We analysed the rate and risk factors for in-hospital community-acquired pneumonia-associated death among non-elderly patients and created a mortality prediction rule based on those risk factors.
  
  
  RESULTS
  We examined 49,370 hospitalisations for patients aged 18-64 years with community-acquired pneumonia. The 30-day fatality rate was 1.5%. Using regression analysis, five risk factors were selected: patient requires help for feeding, the existence of malignancy, confusion, low blood pressure, and age 40-64 years. Each risk factor of our proposed mortality risk scoring system received one point. A total point score for each patient was obtained by summing the points. The negative likelihood ratio for the score 0 group was 0.01, and the positive likelihood ratio for the score ≥4 group was 19.9. The area under the curve of the risk score for non-elderly (0.86, 95% confidence interval: 0.84-0.87) was higher than that of the A-DROP score (0.72, 95% confidence interval: 0.70-0.74) (P < 0.0001).
  
  
  CONCLUSIONS
  Our newly proposed mortality risk scoring system may be appropriate for predicting mortality in non-elderly patients with community-acquired pneumonia. It showed a possibility of a better prediction value than the A-DROP and is easy to use in various clinical settings.
authors.affiliation: Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan. mtashiro@nagasaki-u.ac.jp.|Nagasaki University Infection Control and Education Centre, Nagasaki University Hospital, Nagasaki, Japan. mtashiro@nagasaki-u.ac.jp.
authors.forename: Masato
authors.initials: M
authors.lastname: Tashiro
authors.affiliation: Department of Health Informatics and Policy, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan. kfushimi.hci@tmd.ac.jp.
authors.forename: Kiyohide
authors.initials: K
authors.lastname: Fushimi
authors.affiliation: Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan. takahiro-takazono@nagasaki-u.ac.jp.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Takazono
authors.affiliation: Nagasaki University Infection Control and Education Centre, Nagasaki University Hospital, Nagasaki, Japan. kurihiro@nagasaki-u.ac.jp.
authors.forename: Shintaro
authors.initials: S
authors.lastname: Kurihara
authors.affiliation: Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan. taiga-m@nagasaki-u.ac.jp.
authors.forename: Taiga
authors.initials: T
authors.lastname: Miyazaki
authors.affiliation: Nagasaki University Infection Control and Education Centre, Nagasaki University Hospital, Nagasaki, Japan. tsukamis@nagasaki-u.ac.jp.
authors.forename: Misuzu
authors.initials: M
authors.lastname: Tsukamoto
authors.affiliation: Department of Laboratory Medicine, Nagasaki University Hospital, Nagasaki, Japan. k-yanagi@nagasaki-u.ac.jp.
authors.forename: Katsunori
authors.initials: K
authors.lastname: Yanagihara
authors.affiliation: Department of Respiratory Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan. hmukae@nagasaki-u.ac.jp.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Mukae
authors.affiliation: Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan. tashiro@nagasaki-u.ac.jp.
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Tashiro
authors.affiliation: Department of Respiratory Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan. s-kohno@nagasaki-u.ac.jp.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Kohno
authors.affiliation: Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan. koizumik@nagasaki-u.ac.jp.|Nagasaki University Infection Control and Education Centre, Nagasaki University Hospital, Nagasaki, Japan. koizumik@nagasaki-u.ac.jp.
authors.forename: Koichi
authors.initials: K
authors.lastname: Izumikawa
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000401:mortality*; D015897:Comorbidity; D003221:Confusion / Q000453:epidemiology*; D003661:Decision Support Techniques; D005247:Feeding Behavior; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007022:Hypotension / Q000453:epidemiology*; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology*; D011014:Pneumonia / Q000453:epidemiology / Q000401:mortality*; D012044:Regression Analysis; D012307:Risk Factors; D055815:Young Adult