HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:
Guest Access | Sign In via User Name/Password

This Article Full Text Free Full Text (PDF) Free Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (9) Citing Articles via Google Scholar Google Scholar Articles by Arozullah, A. M. Articles by Yarnold, P. R. Search for Related Content PubMed PubMed Citation Articles by Arozullah, A. M. Articles by Yarnold, P. R.

A Rapid Staging System for Predicting Mortality From HIV-Associated Community-Acquired Pneumonia^*

^* From the VA Chicago Healthcare System (Dr. Arozullah), Westside Division, Department of Medicine, University of Illinois College of Medicine, Chicago; Hines VA Hospital (Dr. Parada), Hines, and Department of Medicine, Loyola University Medical School, Maywood; VA Chicago Healthcare System (Dr. Bennett), Lakeside Division, Chicago; Department of Medicine (Ms. Phan), Northwestern University Medical School, Chicago; Department of Preventive Medicine (Drs. Deloria-Knoll and Chmiel), Northwestern University Medical School, Chicago; and Department of Psychology (Dr. Yarnold), University of Illinois at Chicago, Chicago, IL.

Correspondence to: Ahsan M. Arozullah, MD, MPH, VA Chicago Healthcare System, Westside Division (151WS), 820 S Damen Ave, Chicago, IL 60612; e-mail: arozulla{at}uic.edu

Study objective: Community-acquired pneumonia (CAP) accounts for an increasing proportion of the pulmonary infections in individuals with HIV infection. During the mid-1990s, hospital mortality rates for HIV-associated CAP ranged from 0 to 28%. While hospital differences in case mix may account for mortality rate variation, few methods to evaluate illness severity for HIV-associated CAP have been reported previously. The study objective was to develop a staging system for categorizing mortality risk of patients with HIV-associated CAP using information available prior to hospital admission.

Design/setting/patients: Retrospective medical records review of 1,415 patients hospitalized with HIV-associated CAP from 1995 to 1997 at 86 hospitals in seven metropolitan areas.

Measurements: In-patient mortality rate.

Results: Hierarchically optimal classification tree analysis was used to develop a preadmission staging system for predicting inpatient mortality. The overall inpatient mortality rate was 9.1%. The significant predictors of mortality included the presence of neurologic symptoms, respiratory rate 25 breaths/min, and creatinine > 1.2 mg/dL. The model identified a five-category staging system, with the mortality rate increasing by stage: 2.3% for stage 1, 5.8% for stage 2, 12.9% for stage 3, 22.0% for stage 4, and 40.5% for stage 5. The classification accuracy of the model was 85.2%.

Conclusions: Our staging system categorizes inpatient mortality risk for patients with HIV-associated CAP using three routinely available variables. The staging system may be useful for guiding clinical decisions about the intensity of patient care and for case-mix adjustment in future studies addressing variation in hospital mortality rates.

Key Words: community-acquired pneumonia • HIV • hospital mortality

This article has been cited by other articles:

				C. R. Uphold, M. Deloria-Knoll, F. J. Palella Jr, J. P. Parada, J. S. Chmiel, L. Phan, and C. L. Bennett US Hospital Care for Patients With HIV Infection and Pneumonia: The Role of Public, Private, and Veterans Affairs Hospitals in the Early Highly Active Antiretroviral Therapy Era Chest, February 1, 2004; 125(2): 548 - 556. [Abstract] [Full Text] [PDF]