Patients with community-acquired pneumonia can be divided into risk-associated classes based on clinical and laboratory test findings. The class was also associated with outpatient therapy outcome, length of hospitalization and need for intensive care. Authors participated in the pneumonia Patient Outcomes Research Team (PORT) cohort study.
NOTE: The same authors previously developed the Pittsburgh Pneumonia Prognostic Index (above).
5 classes of risk are identified, with higher class numbers indicating increasing risk.
Steps in Classification:
(1) Is the patient Class I?
(2) If not Class I, identify patient as Class II to V.
|
Is the patient Class I? |
Class I Patients Show All of the Following |
|
patient's age in years |
< 50 |
|
history of a neoplastic disease other than simple skin cancer |
No |
|
history of congestive heart disease |
No |
|
history of cerebrovascular disease |
No |
|
history of renal disease |
No |
|
history of liver disease |
No |
|
altered mental status (disoriented to person, time or place) |
No |
|
heart rate in beats/minute |
< 125 |
|
respiratory rate in breaths/minute |
< 30 |
|
systolic blood pressure in mm Hg |
>= 90 |
|
temperature in °C |
>= 35 and < 40°C |
where:
• Altered mental status is disorientation to person, time or place, that is not chronic, associated with stupor nor associated with coma
|
Parameter |
Finding for Class II-V |
Points |
|
patient's age in years |
|
age in years if male; (age - 10) if female |
|
patient a nursing home resident |
Yes |
10 |
|
history of a neoplastic disease other than simple skin cancer |
Yes |
30 |
|
history of congestive heart disease |
Yes |
10 |
|
history of cerebrovascular disease |
Yes |
10 |
|
history of renal disease |
Yes |
10 |
|
history of liver disease |
Yes |
20 |
|
altered mental status (disoriented to person, time or place) |
Yes |
20 |
|
heart rate in beats/minute |
>= 125 |
10 |
|
respiratory rate in breaths/minute |
>= 30 |
20 |
|
systolic blood pressure in mm Hg |
< 90 |
20 |
|
temperature in °C |
<35 or >= 40°C |
15 |
|
arterial pH |
< 7.35 |
30 |
|
BUN in mg/dL |
>= 30 mg/dL |
20 |
|
sodium in mEq/L |
< 130 mEq/L |
20 |
|
glucose in mg/dL |
>= 250 mg/dL |
10 |
|
hematocrit in percent |
< 30% |
10 |
|
PaO2 in mm Hg |
< 60 mm Hg |
10 |
|
pleural effusion present |
Yes |
10 |
score =
= (sum of all points assigned for clinical findings)
|
Score |
Class |
|
<= 70 |
II |
|
71 - 90 |
III |
|
91 - 130 |
IV |
|
> 130 |
V |
Interpretation
Patients in the higher classes have more severe disease, with higher mortality rate, longer hospitalizations, higher ICU admission rate, and less chance for successful treatment as an outpatient.
|
Class |
Mortality in 30 days |
Admission to ICU |
Median Hospitalization |
|
I |
0.4% |
4.3% |
5.0 days |
|
II |
0.7% |
4.3% |
6.0 days |
|
III |
2.8% |
5.9% |
7.0 days |
|
IV |
8.5% |
11.4% |
9.0 days |
|
V |
31.1% |
17.3% |
11.0 days |
Specialty: Infectious Diseases, Pulmonology
ICD-10: ,
