BACKGROUND: The pneumonia severity index (PSI) accounts for many comorbidities, but not immunosuppression. OBJECTIVES: To document the utility of the PSI to predict mortality in immunocompromised patients (IP) with community-acquired pneumonia (CAP). METHODS: Charts of 284 patients with immunosuppression and CAP were reviewed, and these patients were compared with a contemporary sample of non-IP with CAP. The ability of the PSI to predict mortality was assessed by using multiple logistic regression. Discrimination of the PSI was studied by using the concordance index. RESULTS: Thirty-nine of 284 IP died. Mortality varied according to the etiology of the immunosuppression. Patients with HIV, solid organ transplantation or treatment with immunosuppressive drugs (n=118) had a low in-hospital mortality (4.3%) and were classified as low risk. IP with hematological malignancies, chemotherapy, chest radiation or marrow transplantation (n=166) had a high mortality (20%) and were classified as high risk. Compared with non-IP, low-risk IP had similar PSI-controlled mortality (OR=0.9, P=0.80), whereas high-risk IP had significantly greater mortality (OR=2.8, P<0.0001). The concordance index revealed similar discrimination for the PSI in low-risk IP (0.77) and in non-IP (0.7), but inferior discrimination in high-risk patients (0.6). CONCLUSIONS: Patients with CAP and immunosuppression can be divided into low-risk and high-risk groups. The low-risk IP have mortality similar to non-IP and can be risk stratified by using the PSI.
BACKGROUND: The pneumonia severity index (PSI) accounts for many comorbidities, but not immunosuppression. OBJECTIVES: To document the utility of the PSI to predict mortality in immunocompromised patients (IP) with community-acquired pneumonia (CAP). METHODS: Charts of 284 patients with immunosuppression and CAP were reviewed, and these patients were compared with a contemporary sample of non-IP with CAP. The ability of the PSI to predict mortality was assessed by using multiple logistic regression. Discrimination of the PSI was studied by using the concordance index. RESULTS: Thirty-nine of 284 IP died. Mortality varied according to the etiology of the immunosuppression. Patients with HIV, solid organ transplantation or treatment with immunosuppressive drugs (n=118) had a low in-hospital mortality (4.3%) and were classified as low risk. IP with hematological malignancies, chemotherapy, chest radiation or marrow transplantation (n=166) had a high mortality (20%) and were classified as high risk. Compared with non-IP, low-risk IP had similar PSI-controlled mortality (OR=0.9, P=0.80), whereas high-risk IP had significantly greater mortality (OR=2.8, P<0.0001). The concordance index revealed similar discrimination for the PSI in low-risk IP (0.77) and in non-IP (0.7), but inferior discrimination in high-risk patients (0.6). CONCLUSIONS:Patients with CAP and immunosuppression can be divided into low-risk and high-risk groups. The low-risk IP have mortality similar to non-IP and can be risk stratified by using the PSI.
Authors: M S Niederman; L A Mandell; A Anzueto; J B Bass; W A Broughton; G D Campbell; N Dean; T File; M J Fine; P A Gross; F Martinez; T J Marrie; J F Plouffe; J Ramirez; G A Sarosi; A Torres; R Wilson; V L Yu Journal: Am J Respir Crit Care Med Date: 2001-06 Impact factor: 21.405
Authors: Ahsan M Arozullah; Jorge Parada; Charles L Bennett; Maria Deloria-Knoll; Joan S Chmiel; Laura Phan; Paul R Yarnold Journal: Chest Date: 2003-04 Impact factor: 9.410
Authors: G Hilbert; D Gruson; F Vargas; R Valentino; G Gbikpi-Benissan; M Dupon; J Reiffers; J P Cardinaud Journal: N Engl J Med Date: 2001-02-15 Impact factor: 91.245
Authors: Andrew E Williams; Ricardo J José; Jeremy S Brown; Rachel C Chambers Journal: Am J Physiol Lung Cell Mol Physiol Date: 2015-01-16 Impact factor: 5.464
Authors: Rulan Griesel; Annemie Stewart; Helen van der Plas; Welile Sikhondze; Marc Mendelson; Gary Maartens Journal: AIDS Res Ther Date: 2018-02-12 Impact factor: 2.250
Authors: Carmen Gonzalez; Tami Johnson; Kenneth Rolston; Kelly Merriman; Carla Warneke; Scott Evans Journal: Cancer Med Date: 2014-05-07 Impact factor: 4.452