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Severe community-acquired pneumonia in ICUs: Prospective validation of a prognostic score

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Abstract

Objective

To determine predictors of intensive care unit (ICU) mortality in patients with community-acquired pneumonia (CAP), to develop a pneumonia-specific prognostic index, and to evaluate this index prospectively.

Design

Combined retrospective and prospective clinical study over two periods: January 1987–December 1992 and January 1993–December 1994.

Setting

Four medical ICUs in the north of France.

Patients

Derivation cohort: 335 patients admitted to one ICU were retrospectively studied to determine prognosis factors and to develop a pneumonia-specific prognostic index. Validation cohort: 125 consecutive patients, admitted to four ICUs, were prospectively enrolled to evaluate this index.

Results

In the derivation cohort, 16 predictors of mortality were identified and assigned a value directly proportional to their magnitude in the mortality model: aspiration pneumonia (−0.37), grading of sepsis ≥11 (−0.2), antimicrobial combination (−0.01), Glasgow score >12+mechanical ventilation (MV) (+0.09), serum creatinine ≥15 mg/l (+0.22), chest involvement shown by X-ray ≥3 lobes (+0.28), shock (+0.29), bacteremia (+0.29), initial MV (+0.29), underlying ultimately or rapidly fatal illness (+0.31), Simplified Acute Physiology Score ≥12 (+0.49), neutrophil count ≤3500/mm3 (+0.52), acute organ system failure score ≥2 (+0.64), delayed MV (+0.67), immunosuppression (+1.38), and ineffective initial antimicrobial therapy (+1.5). An index was obtained by adding each patient's points. According to a receiver operating characteristic curve, the cut-off value of this index was 2.5. In the validation cohort, an index of ≥2.5 could predict death with a positive predictive value of 0.92, sensitivity 0.61, and specificity 0.98.

Conclusion

This index, which performs well in classifying patients at high-risk of death, may help physicians in initial patient care (appropriateness of the initial antimicrobial therapy) and guide future clinical research (analysis and design of therapeutic trials).

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Authors and Affiliations

  1. Service de Réanimation Médicale et Maladies Infectieuses, Centre Hospitalier, rue du Président Coty, F-59208, Tourcoing, France

    O. Leroy, H. Georges, C. Beuscart, B. Guery, C. Vandenbussche & G. Beaucaire

  2. Service de Réanimation Médicale, Hôpital B. Chru, Lille University Medical School, F-59037, Lille, France

    C. Coffinier

  3. Service de Réanimation Médicale, Centre Hospitalier, F-62037, Lens, France

    D. Thevenin

  4. Service de Réanimation Médicale, Centre Hospitalier, F-62505, Helfaut, France

    C. Vandenbussche

Authors
  1. O. Leroy
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  2. H. Georges
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  3. C. Beuscart
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  4. B. Guery
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  5. C. Coffinier
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  6. C. Vandenbussche
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  7. D. Thevenin
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  8. G. Beaucaire
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Leroy, O., Georges, H., Beuscart, C. et al. Severe community-acquired pneumonia in ICUs: Prospective validation of a prognostic score. Intensive Care Med 22, 1307–1314 (1996). https://doi.org/10.1007/BF01709543

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  • DOI: https://doi.org/10.1007/BF01709543

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