Repeated pneumonia severity index measurement after admission increases its predictive value for mortality in severe community-acquired pneumonia

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Abstract

Background/Purpose: Severe community-acquired pneumonia (CAP) is associated with high hospital mortality, and accurate assessment of patients is important for supporting clinical decision making. The Pneumonia Severity Index (PSI) is a good tool for predicting disease severity, especially in the low-risk group of patients with CAP. We investigated whether the change in PSI measurement after admission could identify patients at high risk of mortality from CAP. Methods: We prospectively studied 250 inpatients with CAP. PSI was measured at admission and 72 hours later at a tertiary referral medical center from May 2005 to February 2006. The initial and repeated PSI results were compared. Hospital mortality was used as the outcome measure. Results: Initial PSI in high-risk patients (PSI class > IV) had a low specificity (37%), and a low positive predictive value (PPV) (17%). Increased repeated PSI score, as compared with initial score, was associated with an increased mortality rate (from 7.8% to 33.3% in class IV, and 25.3% to 53.3% in class V; p < 0.0001), and improved the predictive value, with 94% specificity and a PPV of 46% for mortality in high-risk patients. Conclusion: Increased PSI score, 72 hours after admission, for patients with CAP improved the predictive value of PSI score and more accurately identified patients with a high risk of mortality.

Original languageEnglish
Pages (from-to)219-223
Number of pages5
JournalJournal of the Formosan Medical Association
Volume108
Issue number3
DOIs
Publication statusPublished - 2009 Jan 1

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Pneumonia
Mortality
Hospital Mortality
Patient Admission
Tertiary Care Centers
Inpatients
Outcome Assessment (Health Care)

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

@article{5c4947b47e0f44a89486c856e6d799f2,
title = "Repeated pneumonia severity index measurement after admission increases its predictive value for mortality in severe community-acquired pneumonia",
abstract = "Background/Purpose: Severe community-acquired pneumonia (CAP) is associated with high hospital mortality, and accurate assessment of patients is important for supporting clinical decision making. The Pneumonia Severity Index (PSI) is a good tool for predicting disease severity, especially in the low-risk group of patients with CAP. We investigated whether the change in PSI measurement after admission could identify patients at high risk of mortality from CAP. Methods: We prospectively studied 250 inpatients with CAP. PSI was measured at admission and 72 hours later at a tertiary referral medical center from May 2005 to February 2006. The initial and repeated PSI results were compared. Hospital mortality was used as the outcome measure. Results: Initial PSI in high-risk patients (PSI class > IV) had a low specificity (37{\%}), and a low positive predictive value (PPV) (17{\%}). Increased repeated PSI score, as compared with initial score, was associated with an increased mortality rate (from 7.8{\%} to 33.3{\%} in class IV, and 25.3{\%} to 53.3{\%} in class V; p < 0.0001), and improved the predictive value, with 94{\%} specificity and a PPV of 46{\%} for mortality in high-risk patients. Conclusion: Increased PSI score, 72 hours after admission, for patients with CAP improved the predictive value of PSI score and more accurately identified patients with a high risk of mortality.",
author = "Chiung-Zuei Chen and Fan, {Po Sheng} and Chien-Chung Lin and Cheng-Hung Lee and Tzuen-Ren Hsiue",
year = "2009",
month = "1",
day = "1",
doi = "10.1016/S0929-6646(09)60055-3",
language = "English",
volume = "108",
pages = "219--223",
journal = "Journal of the Formosan Medical Association",
issn = "0929-6646",
publisher = "Excerpta Medica Asia Ltd.",
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T1 - Repeated pneumonia severity index measurement after admission increases its predictive value for mortality in severe community-acquired pneumonia

AU - Chen, Chiung-Zuei

AU - Fan, Po Sheng

AU - Lin, Chien-Chung

AU - Lee, Cheng-Hung

AU - Hsiue, Tzuen-Ren

PY - 2009/1/1

Y1 - 2009/1/1

N2 - Background/Purpose: Severe community-acquired pneumonia (CAP) is associated with high hospital mortality, and accurate assessment of patients is important for supporting clinical decision making. The Pneumonia Severity Index (PSI) is a good tool for predicting disease severity, especially in the low-risk group of patients with CAP. We investigated whether the change in PSI measurement after admission could identify patients at high risk of mortality from CAP. Methods: We prospectively studied 250 inpatients with CAP. PSI was measured at admission and 72 hours later at a tertiary referral medical center from May 2005 to February 2006. The initial and repeated PSI results were compared. Hospital mortality was used as the outcome measure. Results: Initial PSI in high-risk patients (PSI class > IV) had a low specificity (37%), and a low positive predictive value (PPV) (17%). Increased repeated PSI score, as compared with initial score, was associated with an increased mortality rate (from 7.8% to 33.3% in class IV, and 25.3% to 53.3% in class V; p < 0.0001), and improved the predictive value, with 94% specificity and a PPV of 46% for mortality in high-risk patients. Conclusion: Increased PSI score, 72 hours after admission, for patients with CAP improved the predictive value of PSI score and more accurately identified patients with a high risk of mortality.

AB - Background/Purpose: Severe community-acquired pneumonia (CAP) is associated with high hospital mortality, and accurate assessment of patients is important for supporting clinical decision making. The Pneumonia Severity Index (PSI) is a good tool for predicting disease severity, especially in the low-risk group of patients with CAP. We investigated whether the change in PSI measurement after admission could identify patients at high risk of mortality from CAP. Methods: We prospectively studied 250 inpatients with CAP. PSI was measured at admission and 72 hours later at a tertiary referral medical center from May 2005 to February 2006. The initial and repeated PSI results were compared. Hospital mortality was used as the outcome measure. Results: Initial PSI in high-risk patients (PSI class > IV) had a low specificity (37%), and a low positive predictive value (PPV) (17%). Increased repeated PSI score, as compared with initial score, was associated with an increased mortality rate (from 7.8% to 33.3% in class IV, and 25.3% to 53.3% in class V; p < 0.0001), and improved the predictive value, with 94% specificity and a PPV of 46% for mortality in high-risk patients. Conclusion: Increased PSI score, 72 hours after admission, for patients with CAP improved the predictive value of PSI score and more accurately identified patients with a high risk of mortality.

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