Improving the 2007 Infectious Disease Society of America/American Thoracic Society severe community-acquired pneumonia criteria to predict intensive care unit admission

Oriol Sibila, G. Umberto Meduri, Eric M. Mortensen, Antonio Anzueto, Elena Laserna, Juan F. Fernandez, Ali El-Sohl, Marcos I. Restrepo

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Purpose: To improve 2007 Infectious Disease Society of America/American Thoracic Society (IDSA/ATS) severity criteria to predict intensive care unit (ICU) admission in patients hospitalized with pneumonia. Methods: A composite score that included the 2007 IDSA/ATS criteria for severe pneumonia and additional significant variables identified by recent publications was tested in patients hospitalized with community-acquired pneumonia. Results: Among 787 patients hospitalized with community-acquired pneumonia, 156 (19.8%) required admission to the ICU. We identified one major criterion (arterial pH < 7.30), and 4 minor criteria (tachycardia > 125 bpm, arterial pH 7.30-7.34, sodium < 130 mEq/L and glucose > 250 mg/dL) to be associated with ICU admission. Adding arterial pH < 7.30 to the 2 2007 IDSA/ATS major criteria increased sensitivity from 61.5% to 71.8% and area under the curve (AUC) from 0.80 to 0.86. Adding in sequence the four minor criteria to the 2007 IDSA/ATS minor criteria, increased sensitivity from 41.7% to 53.8%, and AUC from 0.65 to 0.69. In the new composite score, combining 1 of 3 major criteria with 3 of 12 minor criteria showed a sensitivity of 92.9% and an AUC of 0.88. Conclusion: The addition of arterial pH < 7.30 to the 2007 IDSA/ATS major criteria improves sensitivity and AUC to identify patients who will require ICU care.

Original languageEnglish (US)
Pages (from-to)284-290
Number of pages7
JournalJournal of Critical Care
Volume28
Issue number3
DOIs
StatePublished - Jun 2013

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Communicable Diseases
Intensive Care Units
Pneumonia
Area Under Curve
Thorax
Patient Admission
Sodium

Keywords

  • Arterial acidosis
  • Community-acquired pneumonia
  • ICU admission
  • Severity scores

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Improving the 2007 Infectious Disease Society of America/American Thoracic Society severe community-acquired pneumonia criteria to predict intensive care unit admission. / Sibila, Oriol; Meduri, G. Umberto; Mortensen, Eric M.; Anzueto, Antonio; Laserna, Elena; Fernandez, Juan F.; El-Sohl, Ali; Restrepo, Marcos I.

In: Journal of Critical Care, Vol. 28, No. 3, 06.2013, p. 284-290.

Research output: Contribution to journalArticle

Sibila, Oriol ; Meduri, G. Umberto ; Mortensen, Eric M. ; Anzueto, Antonio ; Laserna, Elena ; Fernandez, Juan F. ; El-Sohl, Ali ; Restrepo, Marcos I. / Improving the 2007 Infectious Disease Society of America/American Thoracic Society severe community-acquired pneumonia criteria to predict intensive care unit admission. In: Journal of Critical Care. 2013 ; Vol. 28, No. 3. pp. 284-290.
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