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      Predicting death in patients hospitalized for community-acquired pneumonia.

      Annals of internal medicine
      Adolescent, Adult, Aged, Aged, 80 and over, Anti-Bacterial Agents, therapeutic use, Blood Pressure, Blood Urea Nitrogen, Hospitalization, Humans, Middle Aged, Pneumonia, blood, drug therapy, mortality, physiopathology, Predictive Value of Tests, Prognosis, Regression Analysis, Respiration, Retrospective Studies, Survival Analysis, Virginia

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          Abstract

          To validate a previously reported discriminant rule for predicting mortality in adult patients with primary community-acquired pneumonia and to determine which factors available at hospital admission predict a fatal outcome among such patients. Historical cohort study. University hospital. Adults admitted to the hospital for community-acquired pneumonia. Using stepwise logistic regression, we analyzed prognostic factors (data available at admission and recorded in the medical record) that showed a univariate association with mortality. The predictive values of three discriminant rules were measured to validate the results of a previous study. Of 245 patients, 20 (8.2%) died. Of 42 prognostic factors identified in previous studies, 8 were associated with mortality, but only a respiratory rate of 30/min or more, a diastolic blood pressure of 60 mm Hg or less, and a blood urea nitrogen of more than 7 mmol/L remained predictive in the multivariate analysis. A discriminant rule composed of these three variables was 70% sensitive and 84% specific in predicting mortality, yielding an overall accuracy of 82%. Tachypnea, diastolic hypotension, and an elevated blood urea nitrogen were independently associated with death from pneumonia in our study, confirming the value of a previously reported discriminant rule from the British Thoracic Society. This rule may be useful in triage decisions because it identifies high-risk patients who may benefit from special medical attention.

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