Risk stratification of early admission to the intensive care unit of patients with no major criteria of severe community-acquired pneumonia: development of an international prediction rule.
Crit Care. 2009 Apr 9;13(2):R54
Authors: Renaud B, Labarere J, Coma E, Santin A, Hayon J, Gurgui M, Camus N, Roupie E, Hemery F, Herve J, Salloum M, Fine MJ, Brun-Buisson C
ABSTRACT: INTRODUCTION: To identify risk factors for early (< 3 days) intensive care unit (ICU) admission of patients hospitalized with community-acquired pneumonia (CAP) and not requiring immediate ICU admission and to stratify the risk of ICU admission on days 1-3. METHODS: Using the original data from four North American and European prospective multicenter cohort studies of patients with CAP, we derived and validated a prediction rule for ICU admission on days 1-3 of emergency department (ED) presentation, for patients presenting with no obvious reason for immediate ICU admission (not requiring immediate respiratory or circulatory support). RESULTS: A total of 6560 patients were included (4593 and 1967 in the derivation and validation cohort, respectively), 303 (4.6%) of whom were admitted to an ICU on days 1-3. The Risk of Early Admission to ICU index (REA-ICU index) comprised 11 criteria independently associated with ICU admission: male gender, age < 80 years, comorbid conditions, respiratory rate [greater than or equal to] 30/min, heart rate [greater than or equal to] 125/min, multilobar infiltrate or pleural effusion, white blood cell count < 3 or [greater than or equal to] 20 G/L, hypoxemia (O2 saturation < 90% or PaO2 < 60 mmHg), blood urea nitrogen [greater than or equal to] 11 mmol/L, pH < 7.35, sodium < 130 mEq/L. The REA-ICU index stratified patients into four risk classes with a risk of ICU admission on days 1-3 ranging from 0.7 to 31%. The area under the curve was 0.81 (95% CI 0.78-0.83) in the overall population. CONCLUSIONS: The REA-ICU index accurately stratifies the risk of ICU admission on days 1-3 for patients presenting to the ED with CAP and no obvious indication for immediate ICU admission and therefore may assist orientation decisions.
PMID: 19358736 [PubMed - as supplied by publisher]