Diseño de un índice pronóstico clinico para el manejo de la neumonía del adulto adquirida en la comunidad / Development of an instrument to assess the severity of community acquired pneumonia among hospitalized patients

ABSTRACT

BACKGROUND: Community acquired pneumonia (CAP) severity assessment is crucial. AIM: To develop a practical clinical severity assessment model for stratifying immunocompetent adult patients hospitalized with CAP into different management groups. PATIENTS AND METHODS: During a 24 months period, 455 adult patients (250 male, mean age 69 +/- 19 years old) were evaluated. All the relevant clinical information recorded and they were followed during hospital stay until discharge or death. Mortality until 30 days after admission was determined. RESULTS: The mean hospital length of stay was 9.9 +/- 9.4 days and 76% had an underlying disease. In hospital mortality was 7.6% and 10.1% at 30 days follow up. Admission prognostic factors associated with high mortality at 30 days follow up were: advanced age, presence of comorbidity, suspicion of aspiration, duration of symptoms < or = 2 days, altered mental status, absence of cough, fever and cbills, low blood pressure, tachypnea, hypoxemia and multilobar radiographic pulmonary infiltrates. A clinical prognostic index derived from a logistic regression analysis including five independent variables associated with mortality (confuson, comorbidity, low systolic blood pressure, temperature < 37.5 degrees C and respiratory rate > 20/min), enabled patients to be stratified according to increasing risk of mortality: class 1: 0.9%, class 2: 4.9%, class 3: 14.2%, and class 4: 35.6%. CONCLUSION: A simple clinical severity assessment tool based on confusion, comorbidity, blood pressure, temperature and respiratory rate could be used to stratify patients with CAP into different risk class categories and management groups.