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Severe community-acquired pneumonia Assessment of severity criteria Ewig S; Ruiz M; Mensa J; Marcos MA; Martinez JA; Arancibia F; Niederman MS; Torres AAm J Respir Crit Care Med 1998[Oct]; 158 (4): 1102-8The purpose of the study was to validate the criteria used in the guidelines of the American Thoracic Society (ATS) for severe community-acquired pneumonia (CAP). Severe pneumonia was defined as admission to the intensive care unit (ICU). Overall 331 nonsevere (84%) and 64 severe cases (16%) of CAP were prospectively studied. Mortality was 19 of 395 (5%) and 19 of 64 (30%), respectively. Single severity criteria as well as the ATS definition of severe pneumonia were assessed calculating the operative indices. A modified prediction rule including minor (baseline) and major (baseline or evolutionary) criteria was derived. Single minor criteria at admission had a low sensitivity and positive predictive value. Defining severe pneumonia according to the ATS guidelines had a high sensitivity (98%). However, specificity and positive predictive value were low (32% and 24%, respectively). A modified prediction rule (presence of two or three minor criteria [systolic blood pressure < 90 mm Hg, multilobar involvement, PaO2/FIO2 < 250] or one of two major criteria [requirement of mechanical ventilation, presence of septic shock]) had a sensitivity of 78%, a specificity of 94%, a positive predictive value of 75%, and a negative predictive value of 95%. The ATS definition of severe pneumonia was highly sensitive but insufficiently specific and had a low positive predictive value. Our suggested modified rule had a more balanced performance and, if validated in an independent population, may represent a more accurate definition of severe CAP.|*Severity of Illness Index[MESH]|APACHE[MESH]|Aged[MESH]|Blood Pressure/physiology[MESH]|Community-Acquired Infections/*classification/mortality/surgery[MESH]|Critical Care[MESH]|Disease Progression[MESH]|Female[MESH]|Forecasting[MESH]|Humans[MESH]|Lung/physiopathology[MESH]|Male[MESH]|Middle Aged[MESH]|Patient Admission[MESH]|Pneumonia/*classification/mortality/surgery[MESH]|Practice Guidelines as Topic[MESH]|Predictive Value of Tests[MESH]|Prospective Studies[MESH]|Renal Insufficiency/complications[MESH]|Reproducibility of Results[MESH]|Respiration, Artificial[MESH]|Respiratory Insufficiency/complications[MESH]|Sensitivity and Specificity[MESH]|Shock, Septic/complications[MESH]|Spain/epidemiology[MESH]|Survival Rate[MESH] |
