• Chiung-Zuei Chen, Po-Sheng Fan, Chien-Chung Lin, Cheng-Hung Lee, and Tzuen-Ren Hsiue.
• Department of Internal Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
• J Formos Med Assoc. 2009 Mar 1;108(3):219-23.

Background/PurposeSevere community-acquired pneumonia (CAP) is associated with high hospital mortality, and accurate assessment of patients is important for supporting clinical decision making. The Pneumonia Severity Index (PSI) is a good tool for predicting disease severity, especially in the low-risk group of patients with CAP. We investigated whether the change in PSI measurement after admission could identify patients at high risk of mortality from CAP.MethodsWe prospectively studied 250 inpatients with CAP. PSI was measured at admission and 72 hours later at a tertiary referral medical center from May 2005 to February 2006. The initial and repeated PSI results were compared. Hospital mortality was used as the outcome measure.ResultsInitial PSI in high-risk patients (PSI class > IV) had a low specificity (37%), and a low positive predictive value (PPV) (17%). Increased repeated PSI score, as compared with initial score, was associated with an increased mortality rate (from 7.8% to 33.3% in class IV, and 25.3% to 53.3% in class V; p < 0.0001), and improved the predictive value, with 94% specificity and a PPV of 46% for mortality in high-risk patients.ConclusionIncreased PSI score, 72 hours after admission, for patients with CAP improved the predictive value of PSI score and more accurately identified patients with a high risk of mortality.

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