Simple criteria to assess mortality in patients with community-acquired pneumonia

BACKGROUND AND OBJECTIVES: The Pneumonia Outcomes Research Team (PORT) developed a prediction rule to identify with community-acquired pneumonia (CAP) who are at risk for death and other adverse outcomes. Simpler criteria are needed to evaluate risk of mortality in CAP. PATIENTS AND METHODS: Observational study of patients with CAP admitted to a tertiary care university hospital. Epidemiological, clinical, radiological and laboratory data associated with mortality were analysed. RESULTS: A cohort of 211 patients with CAP was studied. Severity distribution according to PORT score was 12.3%, 15.6%, 19%, 35.5% and 17.5% in groups I, II, III, IV and V, respectively; mean age was 63 years (range, 13 to 100); in 43.6% age was < 65 years; 61.5% patients had >= 1 underlying disease (congestive heart failure in 33.6% and chronic lung disease in 29.9%). Mortality rate was 0% in groups I-II, 2.5% in group III, 5.3% in group IV and 27% in group V. All variables considered in PORT-score were included in a mortality predicting model; factors significantly associated with death were: altered mental status, respiratory rate >= 30/min, pH < 7.35, glucose >= 250 mg/dl and age > 65 years; 99% of patients who had none of these abnormalities survived. CONCLUSIONS: Simpler criteria to assess mortality in CAP were identified. Non-existence of altered mental status, respiratory rate >= 30/min, pH < 7.35, glucose >= 250mg/dl and age > 65 years predicted a non-fatal outcome in 99% of patients. These clinical or laboratory findings should be considered as mortality predictors, can be used as severity adjustment measure and may help physicians make more rational decisions about hospitalization in CAP.