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Severity assessment tools in ICU patients with 2009 influenza A (H1N1) pneumonia.
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2012 (English)In: Clinical Microbiology and Infection, ISSN 1198-743X, E-ISSN 1469-0691, Vol. 18, no 10, 1040-8 p.Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
2012. Vol. 18, no 10, 1040-8 p.
National Category
Medical and Health Sciences
Research subject
Clinical Physiology
URN: urn:nbn:se:uu:diva-191479DOI: 10.1111/j.1469-0691.2011.03736.xPubMedID: 22264290OAI: oai:DiVA.org:uu-191479DiVA: diva2:585729
Available from: 2013-01-10 Created: 2013-01-10 Last updated: 2013-01-10

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