Patient selection: >= 65 years of age with community-acquired pneumonia (presence of new pulmonary infiltrate, signs and symptoms for a lower respiratory tract infection, acquisition outside of a hospital or a health care facility).
Exclusion criteria:
(1) HIV-positive
(2) hospitalized in the 2 weeks prior to admission
(3) admitted from a nursing home or chronic care facility
(4) had another disease that could explain the radiographic findings
Prognostic factors associated with mortality identified by multivariate analysis:
(1) bilateral radiographic infiltrate
(2) tachypnea
(3) elevated urea (serum urea > 7 mmol/L)
(4) absence of fever (temperature < 37.8°C)
(5) confusion
(6) shock (systolic blood pressure < 90 mm Hg, urinary excretion < 20 mL per hour for 4 hours or the need for vasopressors)
total number of prognostic factors =
= SUM(number of factors present)
Interpretation:
• minimum number of prognostic factors: 0
• maximum number of prognostic factors: 6
• The prognostic rule identified patients as high risk for mortality with a total score >= 3.
Performance of rule:
• Sensitivity 61%, specificity 91%.
• Positive predictive value 54%, negative predictive value 93%, overall accuracy 87%.
• 39% of the patients who died had a score < 3.
• Some additional risk factors that might be worth considering are hypothermia and previous immunizations.
