tetano
Editor, Senior Moderator
Clinical Microbiology and Infection
Severity assessment tools in ICU patients with 2009 Influenza A (H1N1) pneumonia
JM Pereira1,
RP Moreno2,
R Matos2,
A Rhodes3,
I Martin-Loeches4,
M Cecconi3,
T Lisboa5,
J Rello6,
on behalf of the ESICM H1N1 Registry Steering Committee and the ESICM H1N1 Registry Contributors?
DOI: 10.1111/j.1469-0691.2011.03736.x
Abstract
The aim of this study was to determine if severity assessment tools (general severity of illness and community-acquired pneumonia specific scores) can be used to guide decisions for patients admitted to the Intensive Care Unit (ICU) due to pandemic influenza A pneumonia. A prospective, observational, multicentre study included 265 patients with mean age of 42 (?16.1) years and an ICU mortality of 31.7%. On admission to the ICU, the mean pneumonia severity index (PSI) score was 103.2 ?43.2 points, the CURB-65 score was 1.7 ?1.1 points and the PIRO-CAP score was 3.2 ?1.5 points. None of the scores had a good predictive ability [area under the ROC for PSI 0.72 (95% CI 0.65-0.78), CURB-65 0.67 (95% CI 0.59-0.74) and PIRO-CAP 0.64 (95% CI 0.56-0.71)]. The PSI score (OR 1.022 (1.009-1.034), p=0.001) was independently associated with ICU mortality however none of the three scores, when used at ICU admission, were able to reliably detect a low risk group of patients. Low risk for mortality was identified in 27.5% of patients using PIRO-CAP, but above 40% when using PSI (I to III) or CURB65 (<2). Observed mortality was 13.7%, 13.5%, and 19.4%, respectively. Pneumonia specific scores undervalued severity and should not be used as instruments to guide decisions in the ICU.
http://onlinelibrary.wiley.com/doi/...+3+Dec+from+10-12+GMT+for+monthly+maintenance
Severity assessment tools in ICU patients with 2009 Influenza A (H1N1) pneumonia
JM Pereira1,
RP Moreno2,
R Matos2,
A Rhodes3,
I Martin-Loeches4,
M Cecconi3,
T Lisboa5,
J Rello6,
on behalf of the ESICM H1N1 Registry Steering Committee and the ESICM H1N1 Registry Contributors?
DOI: 10.1111/j.1469-0691.2011.03736.x
Abstract
The aim of this study was to determine if severity assessment tools (general severity of illness and community-acquired pneumonia specific scores) can be used to guide decisions for patients admitted to the Intensive Care Unit (ICU) due to pandemic influenza A pneumonia. A prospective, observational, multicentre study included 265 patients with mean age of 42 (?16.1) years and an ICU mortality of 31.7%. On admission to the ICU, the mean pneumonia severity index (PSI) score was 103.2 ?43.2 points, the CURB-65 score was 1.7 ?1.1 points and the PIRO-CAP score was 3.2 ?1.5 points. None of the scores had a good predictive ability [area under the ROC for PSI 0.72 (95% CI 0.65-0.78), CURB-65 0.67 (95% CI 0.59-0.74) and PIRO-CAP 0.64 (95% CI 0.56-0.71)]. The PSI score (OR 1.022 (1.009-1.034), p=0.001) was independently associated with ICU mortality however none of the three scores, when used at ICU admission, were able to reliably detect a low risk group of patients. Low risk for mortality was identified in 27.5% of patients using PIRO-CAP, but above 40% when using PSI (I to III) or CURB65 (<2). Observed mortality was 13.7%, 13.5%, and 19.4%, respectively. Pneumonia specific scores undervalued severity and should not be used as instruments to guide decisions in the ICU.
http://onlinelibrary.wiley.com/doi/...+3+Dec+from+10-12+GMT+for+monthly+maintenance