Risk Factors for Increased Morbidity, Complications or Death in Patients with Community Acquired Pneumonia

 

Conditions

 

age > 65 years

 

comorbid illnesses likely to be made worse by the pneumonia

(1) chronic renal failure

(2) ischemic heart disease

(3) congestive heart failure

(4) severe chronic obstructive lung disease

(5) chronic structural disease of lung (bronchiectasis, cystic fibrosis)

 

concurrent malignancy

 

diabetes mellitus

 

post-splenectomy state

 

chronic liver disease of any etiology, including alcoholism

 

immunosuppressive therapy

 

malnutrition

 

suspicion of aspiration (gastric or oropharyngeal secretions)

 

previous hospitalization within past year

 

Physical Findings

 

altered mental status (confusion, decreased level of consciousness)

 

respiratory rate > 30 breaths per minute

 

diastolic blood pressure <= 60 mm Hg, or systolic blood pressure <= 90 mm Hg

 

temperature > 38.3 °C, or hypothermia (< 35 °C)

 

need for mechanical ventilation

 

evidence of extrapulmonary sites of disease (septic arthritis, meningitis, etc.)

 

Laboratory Findings

 

WBC count < 4,000 per µL, or WBC count > 30,000 per µL, or absolute neutrophil count < 1,000 per µL

 

PaO2 < 60 mm Hg on room air, or PaCO2 > 48 mm Hg on room air

 

evidence of abnormal renal function (creatinine > 1.2 mg/dL, or BUN > 20 mg/dL)

 

unfavorable chest radiographic findings (more than one lobe involved, presence of cavity, presence of pleural effusion)

 

rapid progression of pneumonia on chest radiographs (>= 50% increase in the size of the pulmonary opacity within 36 hours)

 

hematocrit < 30 per cent, or hemoglobin < 9 g/dL

 

albumin < 3 g/dL

 

bacteremia

 

other evidence of sepsis or organ dysfunction (metabolic acidosis, increased prothrombin time, increased partial thromboplastin time, or increased fibrin degradation products)

 

Pseudomonas aeruginosa or Staphylococcus aureus as etiologic agents for the pneumonia