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Original Research: CRITICAL CARE MEDICINE |

The Ventilator-Associated Pneumonia PIRO Score: A Tool for Predicting ICU Mortality and Health-Care Resources Use in Ventilator-Associated Pneumonia

Thiago Lisboa, MD; Emili Diaz, MD, PhD; Marcio Sa-Borges, MD; Antonia Socias, MD; Jordi Sole-Violan, MD, PhD; Alejandro Rodríguez, MD, PhD; Jordi Rello, MD, PhD
Author and Funding Information

*From the Critical Care Department (Drs. Lisboa, Diaz, Rodriguez, and Rello), Joan XXIII University Hospital, University Rovira & Virgili, Institut Pere Virgili, CIBER Enfermedades Respiratorias, Tarragona; Intensive Care Unit (Drs. Sa-Borges and Socias), Hospital Son Llatzer, Palma de Mallorca; and Critical Care Department (Dr. Sole-Violan), Dr. Negrin Hospital, Gran Canaria, Spain.

Correspondence to: Jordi Rello MD, PhD, Critical Care Department, Joan XXIII University Hospital, Carrer Dr. Mallafre Guasch 4. (43007) Tarragona, Spain; e-mail: jrello.hj23.ics@gencat.cat


This work as supported by Fondo de Investigaciones Sanitarias (CIBERes 06/06/0036) and AGAUR (2005/SGR/920).

The authors have no conflicts of interest to disclose.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


Chest. 2008;134(6):1208-1216. doi:10.1378/chest.08-1106
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Background:  No score is available to assess severity and stratify mortality risk in ventilator-associated pneumonia (VAP). Our objective was to develop a severity assessment tool for VAP patients.

Methods:  A prospective, observational, cohort study was performed including 441 patients with VAP in three multidisciplinary ICUs. Multivariate logistic regression was performed to identify variables independently associated with ICU mortality. Results were converted into a four-variable score based on the PIRO (predisposition, insult, response, organ dysfunction) concept for ICU mortality risk stratification in VAP patients.

Results:  Comorbidities (COPD, immunocompromise, heart failure, cirrhosis, or chronic renal failure); bacteremia; systolic BP < 90 mm Hg; and ARDS. A simple, four-variable VAP PIRO score was obtained at VAP onset. Mortality varied significantly according to VAP PIRO score (p < 0.001). On the basis of observed mortality for each VAP PIRO score, patients were stratified into three levels of risk: (1) mild, 0 to 1 points; (2) high, 2 points; (3) very high, 3 to 4 points. VAP PIRO score was associated with higher risk of death in Cox regression analysis in the high-risk group (hazard ratio, 2.14; 95% confidence interval [CI], 1.19 to 3.86) and the very-high-risk group (hazard ratio, 4.63; 95% confidence interval, 2.68 to 7.99). Moreover, medical resource use after VAP diagnosis was higher in high-risk and very-high-risk levels compared to patients at mild risk, evaluated using length of ICU stay (mean ± SD, 22.0 ± 10.6 d vs 18.7 ± 12.8 d, p < 0.05) and duration of mechanical ventilation (18.3 ± 10.1 d vs 15.1 ± 11.5 d, p < 0.05).

Conclusions:  VAP PIRO score is a simple, practical clinical tool for predicting ICU mortality and health-care resources use that is likely to assist clinicians in determining VAP severity.

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