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Predicting Death in Patients Hospitalized for Community-acquired Pneumonia

Barry M. Farr, MD, MSC; Andrew J. Sloman, MD; and Michael J. Fisch, MD
[+] Article, Author, and Disclosure Information

Requests for Reprints: Barry Farr, MD, University of Virginia, Health Sciences Center, Box 473, Charlottesville, VA 22908.

Current Author Addresses: Dr. Farr: University of Virginia Health Sciences Center, Box 473, Charlottesville, VA 22908.

Dr. Sloman: University of Iowa Hospitals & Clinics, Department of Internal Medicine, Iowa City, IA 52242.

Dr. Fisch: University of Virginia Health Sciences Center, Box 199, Charlottesville, VA 22908.

© 1991 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1991;115(6):428-436. doi:10.7326/0003-4819-115-6-428
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Objective: To validate a previously reported discriminant rule for predicting mortality in adult patients with primary community-acquired pneumonia and to determine which factors available at hospital admission predict a fatal outcome among such patients.

Design: Historical cohort study.

Setting: University hospital.

Patients: Adults admitted to the hospital for community-acquired pneumonia.

Measurements: Using stepwise logistic regression, we analyzed prognostic factors (data available at admission and recorded in the medical record) that showed a univariate association with mortality. The predictive values of three discriminant rules were measured to validate the results of a previous study.

Main Results: Of 245 patients, 20 (8.2%) died. Of 42 prognostic factors identified in previous studies, 8 were associated with mortality, but only a respiratory rate of 30/min or more, a diastolic blood pressure of 60 mm Hg or less, and a blood urea nitrogen of more than 7 mmol/L remained predictive in the multivariate analysis. A discriminant rule composed of these three variables was 70% sensitive and 84% specific in predicting mortality, yielding an overall accuracy of 82%.

Conclusion: Tachypnea, diastolic hypotension, and an elevated blood urea nitrogen were independently associated with death from pneumonia in our study, confirming the value of a previously reported discriminant rule from the British Thoracic Society. This rule may be useful in triage decisions because it identifies high-risk patients who may benefit from special medical attention.





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