In-hospital mortality risk factors in community acquired pneumonia:
               evaluation of immunocompetent adult patients without comorbidities

Vicco, Miguel Hernan; Ferini, Franco; Rodeles, Luz; Scholtus, Patricia; Long, Ana Karina; Musacchio, Héctor Mario

doi:10.1590/1806-9282.61.02.144

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ORIGINAL ARTICLES • Rev. Assoc. Med. Bras. 61 (2) • mar-apr 2015 • https://doi.org/10.1590/1806-9282.61.02.144 copy

In-hospital mortality risk factors in community acquired pneumonia: evaluation of immunocompetent adult patients without comorbidities

Fatores de risco para mortalidade intra-hospitalar em pneumonia adquirida em comunidade: avaliação de pacientes imunocompetentes sem comorbidades

Authorship SCIMAGO INSTITUTIONS RANKINGS

Summary

Objective:

several scores were developed in order to improve the determination of community acquired pneumonia (CAP) severity and its management, mainly CURB-65 and SACP score. However, none of them were evaluated for risk assessment of in-hospital mortality, particularly in individuals who were non-immunosuppressed and/or without any comorbidity. In this regard, the present study was carried out.

Methods:

we performed a cross-sectional study in 272 immunocompetent patients without comorbidities and with a diagnosis of CAP. Performance of CURB- 65 and SCAP scores in predicting in-hospital mortality was evaluated. Also, variables related to death were assessed. Furthermore, in order to design a model of in-hospital mortality prediction, sampled individuals were randomly divided in two groups. The association of the variables with mortality was weighed and, by multiple binary regression, a model was constructed in one of the subgroups. Then, it was validated in the other subgroup.

Results:

both scores yielded a fair strength of agreement, and CURB-65 showed a better performance in predicting in-hospital mortality. In our casuistry, age, white blood cell counts, serum urea and diastolic blood pressure were related to death. The model constructed with these variables showed a good performance in predicting in-hospital mortality; moreover, only one patient with fatal outcome was not correctly classified in the group where the model was constructed and in the group where it was validated.

Conclusion:

our findings suggest that a simple model that uses only 4 variables, which are easily accessible and interpretable, can identify seriously ill patients with CAP

Keywords:
pneumonia; in-hospital mortality; risk factors

	Low risk (n=72)	Intermediate risk (n=156)	High risk (n=44)	p
Age	43.9±11.8	51.3±11.2	67.7±13.4¹ Patients in the high risk group were older than the remaining ones1	<0.001
Gender (n)
Male	36	73	22	NS
Female	36	83	22
Systolic blood pressure	123.8±15.5 mmHg	117.2±16.4 mmHg	106±20² and had lower levels of systolic2 mmHg	0.001
Diastolic blood pressure	77.6±8 mmHg	70±10 mmHg	60±5³ and diastolic blood pressure.3 mmHg	<0.001
Heart rate	95±17	104+18	101±24	NS
Respiratory frequency	23±3⁴ Compared with low risk patients, all the groups presented higher respiratory frequency.4	29±7	31±8	<0.001
Sepsis (n)
Non-septic	18	19	7	<0.05
Sepsis	54	122⁵ The highest proportions of sepsis5	30
Severe sepsis	-	15⁶ and severe sepsis6	7
Admission in the Intensive Unit Care (n)	6	23⁷ were found in the intermediate risk. Also, this group presented the higher casuistic of patients admitted into the ICU unit.7	7	0.001
Mortality rate (n)	1⁸ In regard to mortality rate, it was increased in those patients stratified as intermediate and high risk.8	9	13	0.001

	Low risk (n=160)	Intermediate risk (n=99)	High risk (n=13)	p
Age	49.5±13.1	55.4±18.5	57.3±19.5	NS
Gender (n)
Male	70	58	3¹ 1 The proportion male to female in the high risk group was lower than in the other risk categories.	<0.0001
Female	90	41	10¹ 1 The proportion male to female in the high risk group was lower than in the other risk categories.
Systolic blood pressure	120.3±17.7 mmHg	115.6±18.3 mmHg	94.2±16.4	NS
Diastolic blood pressure	72.8±12.7 mmHg	69.1±10.3 mmHg	55.3±12.6 mmHg	NS
Heart rate	98±18	107±20	100±23	NS
Respiratory frequency	25±5² 2 Compared with low risk, all the remaining groups presented higher respiratory frequency.	32±8	34±4	<0.001
Sepsis (n)
Non-septic	35	8	1	<0.05
Sepsis	125³ 3 Also, this group presented the higher casuistic of patient with sepsis.	77	4
Severe sepsis	-	4	8
Admission in the Intensive Unit Care (n)	16	15	5⁴ 4 Despite 13 patients were classified as high risk by the SCAP score, this group presented lowest requirement of ICU admission and mortality rate.	0.01
Mortality rate (n)	9	12	2⁴ 4 Despite 13 patients were classified as high risk by the SCAP score, this group presented lowest requirement of ICU admission and mortality rate.	0.01

SCAP score	CURB-65 score
	Low risk	Intermediate	High
		risk	risk
Low risk	68	81	11	160
				(58.8%)
Intermediate	4	71	24	99
risk				(36.4%)
High risk	0	4	9	13
				(4.8%)
	72 (26.5%)	156 (57.4%)	44
			(16.2%)

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[1] * Correspondence: Address: Bv Pellegrini 3551 Santa Fe, Argentina Postal code: 3000 Phone: +543425160636 mvicco@santafe-conicet.gov.ar