Value of the pneumonia severity index in assessment of community-acquired pneumonia

Background and Purpose: The value of the Pneumonia Severity Index (PSI) in predicting the mortality of patients with community-acquired pneumonia has not been reported in Taiwan. This study investigated the value of this scoring system in estimating mortality of inpatients with community-acquired pneumonia. Methods: This was a prospective observational study of 118 inpatients and a ret respective chart review of 115 inpatients with radiographically-confirmed community-acquired pneumonia treated at a tertiary referral medical center in southern Taiwan. Patients were stratified into 5 risk classes according to PSI score. Data on dermographic characteristics, comorbidities, baseline clinical and laboratory features, in-hospital mortality and length of hospital stay were analyzed. Results: The mortality rates according to risk classification were 0% for class I and II, 2.5% for class III, 8.2% for class IV, and 31.2% for class V. A significant correlation was found between these risk classes and medical outcome (p < 0.001). The length of hospital stay was significantly associated with risk, class, and ranged from 6.3 days for class I patients to 18 days for class V (p < 0.001). Conclusion: The PSI provided a useful prediction of medical outcome in patients with community-acquired pneumonia. To decrease unnecessary admission, further prospective studies are needed to determine whether outpatient therapy is appropriate for class I or class II patients with community-acquired pneumonia.