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Related Experiment Videos

Pneumonia severity index in the immunocompromised.

K M Sanders1, Theodore K Marras, Charles K N Chan

  • 1Department of Medicine, University of Toronto, Toronto, Canada.

Canadian Respiratory Journal
|March 22, 2006
PubMed
Summary

The pneumonia severity index (PSI) can predict mortality in immunocompromised patients (IP) with community-acquired pneumonia (CAP). However, the PSI is less accurate for high-risk IP, indicating a need for tailored risk stratification strategies.

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Area of Science:

  • Pulmonary and Critical Care Medicine
  • Infectious Diseases
  • Oncology

Background:

  • The Pneumonia Severity Index (PSI) is a tool for assessing pneumonia risk but does not account for immunosuppression.
  • Immunocompromised patients (IP) with community-acquired pneumonia (CAP) represent a vulnerable population with potentially different risk factors.

Purpose of the Study:

  • To evaluate the effectiveness of the PSI in predicting mortality among IP diagnosed with CAP.
  • To compare the mortality risk of IP with CAP to non-IP using the PSI.

Main Methods:

  • A retrospective chart review of 284 IP with CAP was conducted.
  • IP were categorized into low-risk and high-risk groups based on the etiology of immunosuppression.
  • Logistic regression and concordance index were used to assess PSI's predictive accuracy and discrimination in different IP groups compared to non-IP.

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Main Results:

  • Overall mortality in IP was 13.7% (39/284).
  • Low-risk IP (HIV, transplant, immunosuppressive drugs) had 4.3% mortality, similar to non-IP when controlled by PSI.
  • High-risk IP (hematologic malignancies, chemotherapy, radiation, marrow transplant) had 20% mortality, with PSI showing significantly greater risk (OR=2.8) but inferior discrimination (concordance index=0.6).

Conclusions:

  • IP with CAP can be stratified into low-risk and high-risk groups.
  • The PSI effectively stratifies risk for low-risk IP, showing similar mortality to non-IP.
  • The PSI's predictive accuracy is diminished in high-risk IP, suggesting limitations in its application for this subgroup.