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

Clin Microbiol Infect. 2012 Oct;18(10):1040-8. doi: 10.1111/j.1469-0691.2011.03736.x. Epub 2012 Jan 20.

Abstract

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 (<2). Observed mortality was 13.7%, 13.5% and 19.4%, respectively. Pneumonia-specific scores undervalued severity and should not be used as instruments to guide decisions in the ICU.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Argentina / epidemiology
  • Europe / epidemiology
  • Female
  • Humans
  • Influenza A Virus, H1N1 Subtype / isolation & purification*
  • Influenza, Human / epidemiology*
  • Influenza, Human / virology
  • Intensive Care Units / statistics & numerical data*
  • Male
  • Middle Aged
  • Pneumonia, Viral / epidemiology*
  • Pneumonia, Viral / virology
  • Prospective Studies
  • ROC Curve
  • Severity of Illness Index