Pneumonia Severity Index In Predicting Outcome In Elderly Patients With Community Acquired Pneumonia At A Tertiary Level Hospital In Mumbai

ABSTRACT

Background:Prognostication of patients with community-acquired pneumonia (CAP) is important from clinical, research, and quality-improvement perspectives. The pneumonia severity index (PSI) is a rigorously studied prediction rule for prognosis that objectively stratifies patients into quintiles of risk. The present study aimed to assess whether PSI can predict mortality, need for intensive care and ventilator support. Methods: An observational study of fifty patients aged 60 years or higher who were admitted in the general medicine ward of Department of Medicine, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai from April 2014 till September 2015 was conducted. A questionnaire with demographic information, clinical signs and symptoms, laboratory and radiographic findings was completed for each patient. Patients were classified according to PSI risk classification and their clinical outcome was noted. Results: Mean age of the patients was 66.5± 6.3 years; 68% were males, and 32% were females. The sensitivity, specificity, positive and negative predictive value of PSI risk class IV in predicting ICU admissions was 100%, 55.9%, 40.9% and 100%, respectively. Similarly, the sensitivity and specificity of PSI in predicting death and ventilator support to patient were maximum for PSI class IV. Defervescence time significantly correlated with PSI score (Spearman’s rho = 0.563, p value = 0.001). Conclusion: PSI was a good predictor of mortality, need of ICU admission and mechanical ventilation. Future studies are needed to support our findings and should further assess the long term outcome in these patients.