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PIRO (Predisposition, Insult, Response, Organ Dysfunction) Score of Rello et al for Community-Acquired Pneumonia (CAP)

Purpose: To evaluate an adult with severe community-acquired pneumonia using the PIRO score of Rello et al.

Description

Rello et al developed the PIRO score to evaluate patients with community-acquired pneumonia. This can help to identify patients who may benefit from more aggressive management. The authors are from Joan XXIII University Hospital, University Rovira and Virgili, Institut Pere Virgili (Tarragona, Spain), Corporacio Sanitaria Parc Tauli (Sabadell, Spain) and Northwestern University.


Patient selection: adult with community-acquired pneumonia admitted to the ICU

 

Parameters:

(1) predisposition (P): comorbid conditions (COPD, immunocompromised) and advanced age

(2) insult (I): bacteremia, multilobar opacities on the chest radiograph

(3) response (R): shock and severe hypoxemia

(4) organ dysfunction (O): acute renal failure (ARF) and/or adult respiratory distress syndrome (ARDS)

 

Parameter

Finding

Points

comorbid conditions

absent

0

 

present

1

age

<= 70 years of age

0

 

> 70 years of age

1

bacteremia

absent

0

 

present

1

chest radiograph

normal or single lobe opacities

0

 

multilobar opacities

1

shock

absent

0

 

present

1

hypoxemia

none to moderate

0

 

severe

1

acute renal failure

absent

0

 

present

1

ARDS

absent

0

 

present

1

 

PIRO score =

= SUM(points for the 8 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 8

• The higher the score the more severe the CAP and the higher the mortality rate, the longer the hospitalization and the longer the need for mechanical ventilation.

 

PIRO Score

Risk Group

Mortality Rate

0 to 2

low

4%

3

mild (? mild to moderate)

13%

4

high

43%

5 to 8

very high

76%

 

Performance:

• The area under the ROC curve (AUC) was 0.88.

• The best Youden index was at a cutoff >= 4 (>=4 in text, typographical error in Table 5) with a sensitivity of 86% and specificity of 79%.


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Specialty

Objective

ICD-10