A mortality prediction rule for non-elderly patients with community-acquired pneumonia

作者：Tashiro Masato^*; Fushimi Kiyohide; Takazono Takahiro; Kurihara Shintaro; Miyazaki Taiga; Tsukamoto Misuzu; Yanagihara Katsunori; Mukae Hiroshi; Tashiro Takayoshi; Kohno Shigeru; Izumikawa Koichi

来源：BMC Pulmonary Medicine, 2016, 16(1): 39.

DOI：10.1186/s12890-016-0199-z

• Clinical prediction rule
• Mortality
• Pneumonia
• Young adult
• Middle aged

Background: No mortality prediction rule is suited for non-elderly patients with community-acquired pneumonia. Therefore, we tried to create a mortality prediction rule that is simple and suitable for non-elderly patients with community-acquired pneumonia.
Methods: Because of low mortality at young age, we used information from an administrative database that included A-DROP data. We analysed the rate and risk factors for in-hospital community-acquired pneumonia-associated death among non-elderly patients and created a mortality prediction rule based on those risk factors.
Results: We examined 49,370 hospitalisations for patients aged 18-64 years with community-acquired pneumonia. The 30-day fatality rate was 1.5 %. Using regression analysis, five risk factors were selected: patient requires help for feeding, the existence of malignancy, confusion, low blood pressure, and age 40-64 years. Each risk factor of our proposed mortality risk scoring system received one point. A total point score for each patient was obtained by summing the points. The negative likelihood ratio for the score 0 group was 0.01, and the positive likelihood ratio for the score >= 4 group was 19.9. The area under the curve of the risk score for non-elderly (0.86, 95 % confidence interval: 0.84-0.87) was higher than that of the A-DROP score (0.72, 95 % confidence interval: 0.70-0.74) (P < 0.0001).
Conclusions: Our newly proposed mortality risk scoring system may be appropriate for predicting mortality in non-elderly patients with community-acquired pneumonia. It showed a possibility of a better prediction value than the A-DROP and is easy to use in various clinical settings.

• 出版日期2016-3-8