Severity assessment tools in ICU patients with 2009 influenza A (H1N1) pneumonia.

Pereira, J M; Moreno, R P; Matos, R; Rhodes, A; Martin-Loeches, I; Cecconi, M; Lisboa, T; Rello, J; Rothen, Hans Ulrich (2012). Severity assessment tools in ICU patients with 2009 influenza A (H1N1) pneumonia. Clinical microbiology and infection, 18(10), pp. 1040-1048. Blackwell Publishing 10.1111/j.1469-0691.2011.03736.x

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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 a 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-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.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic of Intensive Care
UniBE Contributor:	Rothen, Hans Ulrich
Subjects:	600 Technology > 610 Medicine & health
ISSN:	1198-743X
Publisher:	Blackwell Publishing
Language:	English
Submitter:	Alessandra Angelini
Date Deposited:	16 Feb 2015 15:21
Last Modified:	05 Dec 2022 14:40
Publisher DOI:	10.1111/j.1469-0691.2011.03736.x
PubMed ID:	22264290
URI:	https://boris.unibe.ch/id/eprint/63103