Prognostic score systems for evaluation of severity in community-acquired bacteraemic pneumococcal pneumonia: utility of the Pneumonia Severity Index (PSI), CURB-65, and modified ATS rules

¹ Unit of Infectious Diseases, Dept of Medicine, Karolinska Institutet, Karolinska University Hospital, Solna, Sweden.
² Unit of Infectious Diseases, Dept of Medicine, Karolinska Institutet, Karolinska University Hospital, Solna, and Dept of Communicable Diseases and Prevention, Stockholm County, Sweden

^* To whom correspondence should be addressed. E-mail: carl.spindler{at}karolinska.se.

	Abstract

To study the accuracy of three score systems, PSI, CURB-65 and mATS, for predicting need of ICU-care and mortality due to bacteraemic pneumococcal pneumonia.

All adult patients (n=114) with invasive pneumococcal pneumonia at Karolinska University Hospital, Sweden, 1999-2000, were included in the study. Severity scores were calculated and the independent prognostic importance of different variables was analysed by multiple regression analyses.

PSI IV, CURB-65 2, and presence of 1 major or >1 minor risk factor in mATS all had a high sensitivity, but somewhat lower specificity for predicting death and need of ICU-care. The death rate was 12% (13/114). The respective severity score and treatment in "other" departments (OD), than the department of infectious diseases (DID), were the only factors independently correlated to death. Patients treated in OD more often had severe underlying illnesses and were more severely ill on admission. However, a significant difference in death rates remained after adjustment for severity between the two groups.

All score systems were useful for predicting need of ICU-care and death due to bacteremic pneumococcal pneumonia. PSI was the most sensitive, but CURB-65 the more easy to use.

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