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Clinical Investigations in Critical Care |

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

Olivier Leroy, MD; Patrick Devos; Benoit Guery, MD; Hughes Georges, MD; Christian Vandenbussche, MD; Cécile Coffinier, MD; Didier Thévenin, MD; Gilles Beaucaire, MD
Author and Funding Information

*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@compuserve.com



Chest. 1999;116(1):157-165. doi:10.1378/chest.116.1.157
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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.

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