• O Leroy, P Devos, B Guery, H Georges, C Vandenbussche, C Coffinier, D Thévenin, and G Beaucaire.
• Service de Réanimation Médicale et Maladies Infectieuses, Université de Lille, Centre Hospitalier, Tourcoing, France. 101331.1077@compuserve.com
• Chest. 1999 Jul 1; 116 (1): 157-65.

Study ObjectivesTo develop a simplified prognostic prediction rule for patients admitted to ICUs for severe community-acquired pneumonia (CAP).SettingSix ICUs in the north of France.PatientsFive hundred five patients admitted to ICUs over a 9-year period (from 1987 to 1995) for severe CAP.InterventionsRetrospective prognosis analysis and multivariate analysis using a credit scoring technique.MeasurementsThe primary outcome measure was ICU mortality.ResultsAmong the 505 patients, 472 were eligible for the prognosis study. The ICU mortality rate was 22.9%. Multivariate analysis identified, on the basis of the patient's medical history and initial examination on ICU admission, six independent predictors of mortality: age > or = 40 years, anticipated death within 5 years, nonaspiration pneumonia, chest radiograph involvement > 1 lobe, acute respiratory failure requiring mechanical ventilation, and septic shock. An initial risk score based on these factors classified patients into three risk classes of increasing mortality: 4% in class I, 25% in class II, and 60% in class III. Multivariate analysis of events occurring during ICU stay identified three independent predictors of mortality: hospital-acquired lower respiratory tract superinfections, nonspecific CAP-related complications, and sepsis-related complications. An adjustment risk score based on these factors was essential to accurately predict the final outcome of patients in the initial risk class II.ConclusionsAs an aid to clinicians in stratifying the prognosis of patients with severe CAP, the simplified prediction rule used in this study could be useful for therapeutic decisions and appropriate care.

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