PURPOSE: To clarify the value of the new severity index in the revised Japanese Respiratory Society Guidelines for the Management of Community-Acquired Pneumonia in Adults (JRS guidelines for CAP) updated in 2005.
METHODS: We retrospectively reviewed the medical records of the individuals who were diagnosed community-acquired pneumonia from January 2000 to October 2005. We employed the new severity assessment tool (A-DROP system) which is based on the simpler and memorable five adverse prognostic features—one point for each of Age: >70 years in male or >75 years in female, Dehydration or Urea nitrogen > 21 mg/ml, Respiration: Sp02 < 90% or PaO2 < 60torr, Orientation: existence of confusion or mental status change and systolic blood Pressure < 90 mm Hg. The patients could be stratified into four groups according to the points system; mild in 0 point, moderate in one or two points, severe in three points and very severe in four or five points respectively. The relation between the severity assessed by A-DROP system and the mortality rate were evaluated.
RESULTS: Five hundreds six episodes of CAP in 443 patients (295 males and 148 females) were enrolled and the median age was 72 years old (17-101 years old). Good relationship is found between the severity of A-DROP system and the mortality; “mild” is 0% (0/180), “moderate” is 2.8% (7/247), “severe” is 13.6% (8/59) and “very severe” is 40.0% (8/20).
CONCLUSION: The severity index of the new JRS guidelines for CAP is not only simpler and easier to use than that in the previous edition, but also good indicator of mortality.
CLINICAL IMPLICATIONS: Even though further prospective studies are needed to assess the true value of this newly adopted assessment tool, A-DROP system could be useful in our practice.
DISCLOSURE: Masateru Kawabata, None.