Prediction of mortality in community-acquired pneumonia in hospitalized patients

Patrick Musonda, Prasanna Sankaran, Deepak N Subramanian, Alexandra C Smith, Philippa Prentice, Syed M Tariq, Ajay V Kamath, Phyo K Myint

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

INTRODUCTION: Community-acquired pneumonia (CAP) is common and associated with a significant mortality. Currently recommended criteria to assess severity of CAP could be improved.

METHODS: We derived 2 new criteria CARSI [confusion, age (<65, ≥65 to <85 or≥ 85), respiratory rate and shock index] and CARASI, where shock index is replaced by temperature-adjusted shock index based on previous observations. By using data of a prospective study performed in Norfolk and Suffolk, United Kingdom, we compare these new indices with the CURB-65 criteria.

RESULTS: A total of 190 patients were included (men, 53%). The age range was 18 to 101 years (median, 76 years). There were a total of 54 deaths during a 6-week follow-up, all within 30 days of admission. Sixty-five (34%) had severe pneumonia by CURB-65. Using CARSI and CARASI, 39 (21%) and 36 (19%) had severe pneumonia, respectively. Sensitivity was slightly less, but specificity was higher with CARSI and CARASI indices than that of CURB-65. Positive and negative predictive values in predicting death during 6-week follow-up were comparable among 3 indices examined. The receiver operating characteristic curve values (95% confidence interval) for the criteria were 0.67 (0.60-0.75) for CURB-65, 0.64 (0.60-0.71) for CARSI and 0.64 (0.57-0.71) for CARASI. Comparing receiver operating characteristic curves for CURB-65 versus CARSI, or CURB-65 versus CARASI, there was no evidence of a difference between the tools, P = 0.35 and 0.33, respectively. There was good agreement, which was strongly statistically significant (kappa = 0.56, P < 0.0001 and kappa = 0.54, P < 0.0001, respectively).

CONCLUSIONS: Both CARSI and CARASI are useful in predicting deaths associated with CAP, including older patients, and may be particularly useful in the emergency and community settings.

Original languageEnglish
Pages (from-to)489-493
Number of pages5
JournalAfrican Journal of Marine Science
Volume342
Issue number6
DOIs
Publication statusPublished - Dec 2011

Fingerprint

pneumonia
mortality
prediction
death
prospective studies
United Kingdom
confidence interval
index
temperature

Keywords

  • adolescent
  • adult
  • aged
  • aged, 80 and over
  • blood pressure
  • body temperature
  • cohort studies
  • community-acquired infections
  • England
  • female
  • follow-up studies
  • hospitalization
  • humans
  • male
  • middle aged
  • pneumonia
  • predictive value of tests
  • prospective studies
  • risk assessment
  • sensitivity and specificity
  • severity of illness index
  • shock
  • statistics, nonparametric
  • young adult

Cite this

Musonda, P., Sankaran, P., Subramanian, D. N., Smith, A. C., Prentice, P., Tariq, S. M., ... Myint, P. K. (2011). Prediction of mortality in community-acquired pneumonia in hospitalized patients. African Journal of Marine Science, 342(6), 489-493. https://doi.org/10.1097/MAJ.0b013e31822cb95f

Prediction of mortality in community-acquired pneumonia in hospitalized patients. / Musonda, Patrick; Sankaran, Prasanna; Subramanian, Deepak N; Smith, Alexandra C; Prentice, Philippa; Tariq, Syed M; Kamath, Ajay V; Myint, Phyo K.

In: African Journal of Marine Science, Vol. 342, No. 6, 12.2011, p. 489-493.

Research output: Contribution to journalArticle

Musonda, P, Sankaran, P, Subramanian, DN, Smith, AC, Prentice, P, Tariq, SM, Kamath, AV & Myint, PK 2011, 'Prediction of mortality in community-acquired pneumonia in hospitalized patients' African Journal of Marine Science, vol. 342, no. 6, pp. 489-493. https://doi.org/10.1097/MAJ.0b013e31822cb95f
Musonda P, Sankaran P, Subramanian DN, Smith AC, Prentice P, Tariq SM et al. Prediction of mortality in community-acquired pneumonia in hospitalized patients. African Journal of Marine Science. 2011 Dec;342(6):489-493. https://doi.org/10.1097/MAJ.0b013e31822cb95f
Musonda, Patrick ; Sankaran, Prasanna ; Subramanian, Deepak N ; Smith, Alexandra C ; Prentice, Philippa ; Tariq, Syed M ; Kamath, Ajay V ; Myint, Phyo K. / Prediction of mortality in community-acquired pneumonia in hospitalized patients. In: African Journal of Marine Science. 2011 ; Vol. 342, No. 6. pp. 489-493.
@article{a7305fef97f9478fabbe2f6aa9d6a342,
title = "Prediction of mortality in community-acquired pneumonia in hospitalized patients",
abstract = "INTRODUCTION: Community-acquired pneumonia (CAP) is common and associated with a significant mortality. Currently recommended criteria to assess severity of CAP could be improved.METHODS: We derived 2 new criteria CARSI [confusion, age (<65, ≥65 to <85 or≥ 85), respiratory rate and shock index] and CARASI, where shock index is replaced by temperature-adjusted shock index based on previous observations. By using data of a prospective study performed in Norfolk and Suffolk, United Kingdom, we compare these new indices with the CURB-65 criteria.RESULTS: A total of 190 patients were included (men, 53{\%}). The age range was 18 to 101 years (median, 76 years). There were a total of 54 deaths during a 6-week follow-up, all within 30 days of admission. Sixty-five (34{\%}) had severe pneumonia by CURB-65. Using CARSI and CARASI, 39 (21{\%}) and 36 (19{\%}) had severe pneumonia, respectively. Sensitivity was slightly less, but specificity was higher with CARSI and CARASI indices than that of CURB-65. Positive and negative predictive values in predicting death during 6-week follow-up were comparable among 3 indices examined. The receiver operating characteristic curve values (95{\%} confidence interval) for the criteria were 0.67 (0.60-0.75) for CURB-65, 0.64 (0.60-0.71) for CARSI and 0.64 (0.57-0.71) for CARASI. Comparing receiver operating characteristic curves for CURB-65 versus CARSI, or CURB-65 versus CARASI, there was no evidence of a difference between the tools, P = 0.35 and 0.33, respectively. There was good agreement, which was strongly statistically significant (kappa = 0.56, P < 0.0001 and kappa = 0.54, P < 0.0001, respectively).CONCLUSIONS: Both CARSI and CARASI are useful in predicting deaths associated with CAP, including older patients, and may be particularly useful in the emergency and community settings.",
keywords = "adolescent, adult, aged, aged, 80 and over, blood pressure, body temperature, cohort studies, community-acquired infections, England, female, follow-up studies, hospitalization, humans, male, middle aged, pneumonia, predictive value of tests, prospective studies, risk assessment, sensitivity and specificity, severity of illness index, shock, statistics, nonparametric, young adult",
author = "Patrick Musonda and Prasanna Sankaran and Subramanian, {Deepak N} and Smith, {Alexandra C} and Philippa Prentice and Tariq, {Syed M} and Kamath, {Ajay V} and Myint, {Phyo K}",
year = "2011",
month = "12",
doi = "10.1097/MAJ.0b013e31822cb95f",
language = "English",
volume = "342",
pages = "489--493",
journal = "African Journal of Marine Science",
issn = "1814-232X",
publisher = "National Inquiry Services Centre Ltd",
number = "6",

}

TY - JOUR

T1 - Prediction of mortality in community-acquired pneumonia in hospitalized patients

AU - Musonda, Patrick

AU - Sankaran, Prasanna

AU - Subramanian, Deepak N

AU - Smith, Alexandra C

AU - Prentice, Philippa

AU - Tariq, Syed M

AU - Kamath, Ajay V

AU - Myint, Phyo K

PY - 2011/12

Y1 - 2011/12

N2 - INTRODUCTION: Community-acquired pneumonia (CAP) is common and associated with a significant mortality. Currently recommended criteria to assess severity of CAP could be improved.METHODS: We derived 2 new criteria CARSI [confusion, age (<65, ≥65 to <85 or≥ 85), respiratory rate and shock index] and CARASI, where shock index is replaced by temperature-adjusted shock index based on previous observations. By using data of a prospective study performed in Norfolk and Suffolk, United Kingdom, we compare these new indices with the CURB-65 criteria.RESULTS: A total of 190 patients were included (men, 53%). The age range was 18 to 101 years (median, 76 years). There were a total of 54 deaths during a 6-week follow-up, all within 30 days of admission. Sixty-five (34%) had severe pneumonia by CURB-65. Using CARSI and CARASI, 39 (21%) and 36 (19%) had severe pneumonia, respectively. Sensitivity was slightly less, but specificity was higher with CARSI and CARASI indices than that of CURB-65. Positive and negative predictive values in predicting death during 6-week follow-up were comparable among 3 indices examined. The receiver operating characteristic curve values (95% confidence interval) for the criteria were 0.67 (0.60-0.75) for CURB-65, 0.64 (0.60-0.71) for CARSI and 0.64 (0.57-0.71) for CARASI. Comparing receiver operating characteristic curves for CURB-65 versus CARSI, or CURB-65 versus CARASI, there was no evidence of a difference between the tools, P = 0.35 and 0.33, respectively. There was good agreement, which was strongly statistically significant (kappa = 0.56, P < 0.0001 and kappa = 0.54, P < 0.0001, respectively).CONCLUSIONS: Both CARSI and CARASI are useful in predicting deaths associated with CAP, including older patients, and may be particularly useful in the emergency and community settings.

AB - INTRODUCTION: Community-acquired pneumonia (CAP) is common and associated with a significant mortality. Currently recommended criteria to assess severity of CAP could be improved.METHODS: We derived 2 new criteria CARSI [confusion, age (<65, ≥65 to <85 or≥ 85), respiratory rate and shock index] and CARASI, where shock index is replaced by temperature-adjusted shock index based on previous observations. By using data of a prospective study performed in Norfolk and Suffolk, United Kingdom, we compare these new indices with the CURB-65 criteria.RESULTS: A total of 190 patients were included (men, 53%). The age range was 18 to 101 years (median, 76 years). There were a total of 54 deaths during a 6-week follow-up, all within 30 days of admission. Sixty-five (34%) had severe pneumonia by CURB-65. Using CARSI and CARASI, 39 (21%) and 36 (19%) had severe pneumonia, respectively. Sensitivity was slightly less, but specificity was higher with CARSI and CARASI indices than that of CURB-65. Positive and negative predictive values in predicting death during 6-week follow-up were comparable among 3 indices examined. The receiver operating characteristic curve values (95% confidence interval) for the criteria were 0.67 (0.60-0.75) for CURB-65, 0.64 (0.60-0.71) for CARSI and 0.64 (0.57-0.71) for CARASI. Comparing receiver operating characteristic curves for CURB-65 versus CARSI, or CURB-65 versus CARASI, there was no evidence of a difference between the tools, P = 0.35 and 0.33, respectively. There was good agreement, which was strongly statistically significant (kappa = 0.56, P < 0.0001 and kappa = 0.54, P < 0.0001, respectively).CONCLUSIONS: Both CARSI and CARASI are useful in predicting deaths associated with CAP, including older patients, and may be particularly useful in the emergency and community settings.

KW - adolescent

KW - adult

KW - aged

KW - aged, 80 and over

KW - blood pressure

KW - body temperature

KW - cohort studies

KW - community-acquired infections

KW - England

KW - female

KW - follow-up studies

KW - hospitalization

KW - humans

KW - male

KW - middle aged

KW - pneumonia

KW - predictive value of tests

KW - prospective studies

KW - risk assessment

KW - sensitivity and specificity

KW - severity of illness index

KW - shock

KW - statistics, nonparametric

KW - young adult

U2 - 10.1097/MAJ.0b013e31822cb95f

DO - 10.1097/MAJ.0b013e31822cb95f

M3 - Article

VL - 342

SP - 489

EP - 493

JO - African Journal of Marine Science

JF - African Journal of Marine Science

SN - 1814-232X

IS - 6

ER -