Mehr et al developed equations for predicting short term mortality risk in nursing home residents with lower respiratory tract infections. This can be help identify patients who may require closer monitoring and more aggressive interventions. The authors are from the University of Missouri, Washington University in St, Louis and Boston University.
Patient selection: nursing home resident with <= 4 lower respiratory tract infections
Parameters:
(1) serum urea nitrogen
(2) white blood cell count
(3) absolute lymphocyte count
(4) pulse
(5) gender
(6) activities of daily living using 0-4 scale (see below)
(7) body mass index (kilograms per square meter)
(8) recent deterioration in mood
Activities of daily living:
(1) grooming
(2) using the toilet
(3) locomotion
(4) eating
Each activity of daily living is scored 1 if s/he requires extensive assistance or is totally dependent, else scored 0.
|
Parameter |
Finding |
Value to Use |
|
serum urea nitrogen |
< 10 |
10 |
|
|
10 – 80 |
(SUN) |
|
|
> 80 |
80 |
|
white blood cell count |
< 5,000 per µL |
5 |
|
|
5,000 – 30,000 |
(WBC) / 1,000 |
|
|
> 30,000 per µL |
30 |
|
absolute lymphocyte count |
< 800 per µL |
1 |
|
|
>= 800 per µL |
0 |
|
pulse in beats per minute |
< 60 |
60 |
|
|
60 – 140 |
(pulse) |
|
|
> 140 |
140 |
|
gender |
male |
1 |
|
|
female |
0 |
|
activities of daily living |
independent |
0 |
|
|
dependent in 1 activity |
1 |
|
|
dependent in 2 activities |
2 |
|
|
dependent in 3 activities |
3 |
|
|
dependent in 4 activities |
4 |
|
body mass index |
< 12 kg per square meter |
12 |
|
|
12 – 35 |
(BMI) |
|
|
> 35 kg per square meter |
35 |
|
deterioration in mood over the past 90 days |
yes |
1 |
|
|
no |
0 |
X =
= (0.046 * (value for serum urea nitrogen)) + (0.052 * (value for WBC count)) + (0.613 * (value for absolute lymphocyte count)) + (0.017 * (value for pulse)) + (0.555 * (value for gender)) + (0.310 * (value for activities of daily living)) - (0.089 * (value for BMI)) + (0.970 * (value for mood)) – 4.53
probability of 30 day mortality =
= 1 / (1 + EXP((-1) * X))
Simplified Point Score Version
|
Parameter |
Finding |
Points |
|
serum urea nitrogen |
<= 16 mg/dL |
0 |
|
|
16.1 – 27 |
1 |
|
|
27.1 – 38 |
2 |
|
|
38.1 – 49 |
3 |
|
|
49.1 – 60 |
4 |
|
|
60.1 – 71 |
5 |
|
|
> 71 |
6 |
|
white blood cell count |
<= 14,000 per µL |
0 |
|
|
14,100 – 24,000 per µL |
1 |
|
|
> 24,000 per µL |
2 |
|
absolute lymphocyte count |
> 800 per µL |
0 |
|
|
<= 800 per µL |
1 |
|
pulse |
<= 72 beats per minute |
0 |
|
|
73 – 102 |
1 |
|
|
103- 132 |
2 |
|
|
> 132 |
3 |
|
gender |
female |
0 |
|
|
male |
1 |
|
Specialty: Infectious Diseases, Pulmonology ICD-10: , |
