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