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Clinical Investigations: PNEUMONIA |

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

Ahsan M. Arozullah; Jorge Parada; Charles L. Bennett; Maria Deloria-Knoll; Joan S. Chmiel; Laura Phan; Paul R. Yarnold
Author and Funding Information

*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@uic.edu



Chest. 2003;123(4):1151-1160. doi:10.1378/chest.123.4.1151
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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.

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