Community-acquired pneumonia: a clinical prediction rule can help rank patients for risk of dying

Clinical bottom line (level 1a)

  1. A clinical prediction rule can help rank patients with community-acquired pneumonia for risk of dying.
Marras et al: Chest 2000; 118 : 1339-1343
Fine et al: New England Journal of Medicine 1997; 336 : 243-250
Expires October 2004

The study

Retrospective cohort study with objective outcomes, adjusted for confounding factors, validated in an independent set of patients.

Setting: 2 university hospitals, Canada

244 patients (aged ? - 89% > 50, 55% male) with a community-acquired pneumonia

Excluded if
  • HIV infection or otherwise immunosuppressed
  • suspected to have active tuberculosis
  • chart unavailable

    Patients were ranked for risk of mortality using a clinical prediction rule developed by Fine et al based on 20 clinical and laboratory variables.

    100% followed for hospital stay
    Outcomes studied:
  • death
  • class V: death
  • class IV: death
  • class III: death
  • class II: mortality
  • class I: death

    The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)    		 NNF
    (95% CI)
    death hospital stay 31/244 13%
    (8.5% to 17%)    		 8
    (6 to 12)
    class V: death hospital stay 25/72 35%
    (24% to 46%)    		 3
    (2 to 4)
    class IV: death hospital stay 3/101 3.0%
    (0.0% to 6.3%)    		 34
    (16 to infinity)
    class III: death hospital stay 3/32 9.4%
    (0.0% to 20%)    		 11
    (5 to infinity)
    class II: mortality hospital stay 0/23 0.0%
    (0.0% to 12%)    		 -
    (8 to infinity)
    class I: death hospital stay 0/16 0.0%
    (0.0% to 17%)    		 -
    (6 to infinity)

    Comments

    1. The study is too small to provide useful confidence intervals for the lower risk groups.
    2. 94% of patients in the lower 3 classes had additional reasons for admission - 25% due to psychosocial problems.

    Citation

    1. Marras TK, Gutierrez C, Chan CK: applying a prediction rule to identify low-risk patients with community-acquired pneumonia. Chest 2000; 118 : 1339-1343
    2. Fine MJ, Auble TE, Yealy DM, et al: a prediction rule to identify low-risk patients with community-acquired pneumonia. New England Journal of Medicine 1997; 336 : 243-250
    Search Terms: from ACP Journal Club other articles noted
    Contributor: Chris Ball, October 2001
    Reviewer:

    Clinical Question.
    Patient
    Intervention or Exposure
    Outcome