Elsevier

Respiratory Medicine

Volume 105, Issue 10, October 2011, Pages 1543-1549
Respiratory Medicine

Weight of the IDSA/ATS minor criteria for severe community-acquired pneumonia

https://doi.org/10.1016/j.rmed.2011.06.010Get rights and content
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Summary

Background

The 2007 Infectious Disease Society of America (IDSA)/American Thoracic Society (ATS) guidelines defined severe community-acquired pneumonia (CAP) when patients fulfilled three out of nine minor criteria. Whether each of the criteria is of equal weight is not clear. The purpose of this study was to determine the weight of the minor criteria.

Methods

1230 adult patients admitted to our hospital from 2005 to 2009 for CAP were reviewed retrospectively.

Results

Hospital mortality rose sharply from 0.3%, 1.0% and 3.3%, respectively, for patients with none, one and two minor criteria to 10.5% for patients with three minor criteria. Arterial oxygen pressure/fraction inspired oxygen (PaO2/FiO2) ≤ 250 mm Hg, confusion, and uremia had the strongest association with mortality (Odds ratio, 22.162, 22.148, 16.343; respectively). Leukopenia, hypothermia, and hypotension were not associated with mortality. Confusion and uremia showed independent relationships with mortality (Odds ratio, 9.296, 8.493; respectively). Sequential organ failure assessment (SOFA) scores and costs increased significantly with the number of minor criteria present. Uremia and PaO2/FiO2 ≤ 250 mm Hg were most strongly associated with SOFA scores [rank correlation coefficient (rs), 0.352, 0.336; respectively]. PaO2/FiO2 ≤ 250 mm Hg and confusion were in closest relation to hospital length of stay (LOS) (rs, 0.114, 0.114; respectively). PaO2/FiO2 ≤ 250 mm Hg and multilobar infiltrates were most strongly associated with costs (rs, 0.257, 0.196; respectively).

Conclusions

The individual 2007 IDSA/ATS minor criteria for severe CAP were of unequal weight in predicting hospital mortality, SOFA scores, hospital LOS, and costs.

Keywords

Community-acquired pneumonia
Severity
Minor criteria
Association
Weight

Cited by (0)

The abstract (NO. 503) has been accepted for Oral Presentation at the ERS (European Respiratory Society) Amsterdam 2011 Annual Congress (24-28 September).

e

These authors are joint first authors.