Pneumonia Severity Index Class V Patients With Community-Acquired Pneumonia* Characteristics, Outcomes, and Value of Severity Scores

Background: Community-acquired pneumonia (CAP) with a pneumonia severity index (PSI) score in risk class V (PSI-V) is a potentially life-threatening condition, yet the majority of patients are not admitted to the ICU. The aim of this study was to characterize CAP patients in PSI-V to determine the risk factors for ICU admission and mortality, and to assess the performance of CAP severity scores in this population. Methods: Prospective observational study including hospitalized adults with CAP in PSI-V from 1996 to 2003. Clinical and laboratory data, microbiological findings, and outcomes were recorded. The PSI score; modified American Thoracic Society (ATS) score; the confusion, urea, respiratory rate, low BP (CURB) score, and CURB plus age of> 65 years score were calculated. A reduced score based on the acute illness variables contained in the PSI was also obtained. Results: A total of 457 patients were included in the study (mean [ SD] age, 79 11 years), of whom 92 (20%) were admitted to the ICU. Patients in the ward were older (mean age, 82 10 vs 70 10 years, respectively) and had more comorbidities. ICU patients experienced signifi-cantly more acute organ failures. The mortality rate was higher in ICU patients, but also was high for non-ICU patients (37 % vs 20%, respectively; p 0,003). A low level of consciousness (odd