Severity assessment tools in ICU patients with 2009 Influenza A (H1N1) pneumonia

The aim of this study was to determine if severity assessment tools (general severity of illness and community-acquired pneumonia specific scores) can be used to guide decisions for patients admitted to the intensive care unit (ICU) due to pandemic influenza A pneumonia. A prospective, observational...

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Bibliographic Details
Published in:	Clinical microbiology and infection 2012-10, Vol.18 (10), p.1040-1048
Main Authors:	Pereira, J.M., Moreno, R.P., Matos, R., Rhodes, A., Martin-Loeches, I., Cecconi, M., Lisboa, T., Rello, J.
Format:	Article
Language:	eng
Subjects:	Adult Age Aged Argentina - epidemiology Biological and medical sciences Clinical Physiology Critically ill Europe - epidemiology Female Human viral diseases Humans Infectious diseases Influenza A influenza A (H1N1)v Influenza A Virus, H1N1 Subtype - isolation & purification Influenza, Human - epidemiology Influenza, Human - virology Intensive care units Intensive Care Units - statistics & numerical data Klinisk fysiologi Male Medical sciences Middle Aged Mortality pandemics Pneumology Pneumonia Pneumonia, Viral - epidemiology Pneumonia, Viral - virology Prospective Studies Respiratory system : syndromes and miscellaneous diseases Risk factors Risk groups ROC Curve Severity of Illness Index severity scores triage Viral diseases Viral diseases of the respiratory system and ent viral diseases
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Summary:	The aim of this study was to determine if severity assessment tools (general severity of illness and community-acquired pneumonia specific scores) can be used to guide decisions for patients admitted to the intensive care unit (ICU) due to pandemic influenza A pneumonia. A prospective, observational, multicentre study included 265 patients with a mean age of 42 (±16.1) years and an ICU mortality of 31.7%. On admission to the ICU, the mean pneumonia severity index (PSI) score was 103.2 ± 43.2 points, the CURB-65 score was 1.7 ± 1.1 points and the PIRO-CAP score was 3.2 ± 1.5 points. None of the scores had a good predictive ability: area under the ROC for PSI, 0.72 (95% CI, 0.65-0.78); CURB-65, 0.67 (95% CI, 0.59-0.74); and PIRO-CAP, 0.64 (95% CI, 0.56-0.71). The PSI score (OR, 1.022 (1.009-1.034), p 0.001) was independently associated with ICU mortality; however, none of the three scores, when used at ICU admission, were able to reliably detect a low-risk group of patients. Low risk for mortality was identified in 27.5% of patients using PIRO-CAP, but above 40% when using PSI (I–III) or CURB65 (
ISSN:	1198-743X 1469-0691 1469-0691