Prognosis

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

Why?

A clinical prediction rule can help predict mortality at 30 days

score a	LR  (95% CI)	% dead at 30 days  (95% CI)	NNF  (95% CI)	% admitted to ITU at 30 days   (95% CI)	NNF  (95% CI)
>130	7.1  (5.7 to 8.9)	27%  (21% to 33%)	4  (3 to 5)	17%  (12% to 22%)	6  (4 to 8)
91 to 130	2.0  (1.5 to 2.5)	9.3%  (6.7% to 12%)	11  (8 to 15)	11%  (8.5% to 14%)	9  (7 to 12)
71 to 90	0.18  (0.058 to 0.55)	0.92% (0.0% to 2.0%)	110  (51 to infinity)	5.9%  (3.0% to 8.8%)	17  (11 to 33)
<70	0.12  (0.040 to 0.37)	0.63% (0.0% to 1.3%)	160  (75 to infinity)	4.3%  (1.7% to 6.9%)	23  (15 to 59)
aged < 50 and none of the conditions or physical findings listed	0.025 (0.0035 to 0.18)	0.13% (0.0% to 0.38%)	770  (260 to infinity)	4.3%  (1.4% to 7.3%)	23  (14 to 72)