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A validation and potential modification of the pneumonia severity index in elderly patients with community-acquired
Tateaki Naito1, Takafumi Suda, Kazumasa Yasuda
1Department of Internal Medicine, Second Division, Hamamatsu University School of Medicine, Hamamatsu, Japan.
Objectives:
To evaluate the discriminatory power of the Pneumonia Severity Index (PSI) in elderly patients with community-acquired pneumonia (CAP) and to improve its performance.
Design:
Retrospective review of 193 patients from 1999 to 2001 to derive prognostic rules. The rules were prospectively validated in 144 patients from 2002 to 2003.
Setting:
Iwata City Hospital, a 400-bed general hospital.
Participants:
Patients aged 80 and older who had CAP and were admitted to the hospital.
Measurements:
Predictors of 30-day mortality were identified using logistic regression analysis, and several rules were constructed by combining the PSI and the independent predictors.
Results:
The original PSI, which defines PSI Class IV and V as a high-risk group, did not perform well in discriminating survivors from nonsurvivors (sensitivity 100%, specificity 15%), whereas a modified PSI, which defines only PSI Class V as a high-risk group, performed better (sensitivity 86%, specificity 63%). Three predictors for mortality were identified independent from the modified PSI: performance status (PS) Grade 3 or higher, anorexia, and partial pressure of carbon dioxide of 50 mmHg or greater. By combining the modified PSI and PS, the performance could be further improved (sensitivity 79%, specificity 80%).
Conclusion:
The modified PSI could identify low-risk patients more accurately than the original PSI. In addition, by combining the modified PSI with PS, higher performance was obtained. Such information would aid physicians in clinical decision-making without overestimating the risk for elderly patients with CAP.
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