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Simplified Prediction Rule for Prognosis of Patients With Severe Community-Acquired Pneumonia in ICUs^*

^* From the Service de Réanimation Médicale et Maladies Infectieuses (Drs. Leroy, Guery, Georges, and Beaucaire), Université de Lille, Centre Hospitalier, Tourcoing, France; CERIM (Mr. Devos), Centre Hospitalier Régional Universitaire, Lille, France; Service de Réanimation Médicale (Dr. Vandenbussche), Centre Hospitalier, Arras, France; Service de Réanimation Médicale (Dr. Coffinier), Centre Hospitalier, Valenciennes, France; and Service de Réanimation Médicale (Dr. Thevenin), Centre Hospitalier, Lens, France.

Correspondence to: Olivier Leroy, MD, Service de Réanimation Médicale et Maladies Infectieuses, Centre Hospitalier, Rue du Président Coty, 59208 Tourcoing, France; e-mail: 101331.1077{at}compuserve.com

Study objectives: To develop a simplified prognostic prediction rule for patients admitted to ICUs for severe community-acquired pneumonia (CAP).

Setting: Six ICUs in the north of France.

Patients: Five hundred five patients admitted to ICUs over a 9-year period (from 1987 to 1995) for severe CAP.

Interventions: Retrospective prognosis analysis and multivariate analysis using a credit scoring technique.

Measurements: The primary outcome measure was ICU mortality.

Results: Among the 505 patients, 472 were eligible for the prognosis study. The ICU mortality rate was 22.9%. Multivariate analysis identified, on the basis of the patient's medical history and initial examination on ICU admission, six independent predictors of mortality: age 40 years, anticipated death within 5 years, nonaspiration pneumonia, chest radiograph involvement > 1 lobe, acute respiratory failure requiring mechanical ventilation, and septic shock. An initial risk score based on these factors classified patients into three risk classes of increasing mortality: 4% in class I, 25% in class II, and 60% in class III. Multivariate analysis of events occurring during ICU stay identified three independent predictors of mortality: hospital-acquired lower respiratory tract superinfections, nonspecific CAP-related complications, and sepsis-related complications. An adjustment risk score based on these factors was essential to accurately predict the final outcome of patients in the initial risk class II.

Conclusions: As an aid to clinicians in stratifying the prognosis of patients with severe CAP, the simplified prediction rule used in this study could be useful for therapeutic decisions and appropriate care.

Key Words: community-acquired pneumonia • intensive care • prognostic score

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