Prognosis

• admitted to hospital
• elderly
• from a nursing home
• bacteraemic
• requiring intensive care

Determine your patient's risk of dying in the next month ^a using the following scoring system.

Risk of dying from pneumonia: sum the components

Prognostic factor a	score
age	(years) for men; (years) - 10 for women
nursing home resident	+10
co-existing disease
- neoplastic disease	+30
- liver disease	+20
- congestive heart failure	+10
- cerebrovascular disease	+10
- renal disease	+10
physical examination findings
- altered mental status	+20
- respiratory rate 30/minute or more	+20
systolic blood pressure < 90 mmHg	+20
temperature ≤35 C or ≥40 C	+15
pulse ≥ 125 beats/min	+10
laboratory and radiographic findings
arterial pH < 7.35	+30
urea ≥ 11 mmol/l	+20
sodium <130 mmol/l	+20
glucose ≥ 14 mmol/l	+10
haematocrit < 30%	+10
pO2 < 8.0 pKa	+10
pleural effusion	+10

Risk of dying from pneumonia: rank your patient

score a	class	risk of dying
>130	V	high
91 to 130	IV	moderate
71 to 90	III	low
<70	II	low
aged < 50 and none of the conditions or physical findings listed	I	low

Note: elderly patients who survive an episode of community-acquired pneumonia remain at increased risk of dying, particularly from pneumonia. ^a