Azoulay et al developed a predictive model for Pneumocystis jirovecii pneumonia (PJP) in a patient with a hematologic malignancy and acute respiratory failure. The authors are from multiple institutions in France.
Patient selection: hematologic malignancy and acute respiratory failure
Parameters:
(1) age in years
(2) diagnosis
(3) PJP prophylaxis
(4) number of days between onset of respiratory symptoms and ICU admission
(5) shock on ICU admission
(6) chest X-ray findings
(7) pleural effusion
Parameter
Finding
Points
age in years
< 50 years
0
50 to 70 years
-1.5
> 70 years
-2.5
diagnosis
lymphoproliferative disorder
2
other
0
PJP prophylaxis
no
1
yes
0
days between onset and ICU admission
< 3 days
0
3 to 5 days
3
> 5 days
3
shock on ICU admission
no
0
yes
-1.5
chest X-ray
alveolar
0
non-alveolar
2.5
pleural effusion
no
0
yes
-2
total score =
= SUM(points for all 7 parameters)
Interpretation:
• minimum score: -6
• maximum score: 8.5
• A score >= 3 had a sensitivity of 87% and specificity of 68%. The negative predictive value was 98% at a 10% prevalence.
Performance:
• The area under the ROC curve is 0.80 in derivation cohort and 0.83 in the validation cohort.
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