Weight of the IDSA/ATS minor criteria for severe community-acquired pneumonia

Guo, Qi; Li, Haiyan; Zhong, Yiping; Li, Ming; Chen, Xiaoke; Liu, Hui; Peng, Hong-lin; Yu, Hai-Qiong; Chen, Xia; Liu, Nian; Liu, Liang; Zhao, Qing-zhou; Jiang, Mei

doi:10.1016/j.rmed.2011.06.010

Cited by 19 publications

(20 citation statements)

References 21 publications

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“…We reported that PaO 2 /FiO 2 ≤ 250 mm Hg, confusion and uremia had the strongest association with mortality, and that leukopenia, hypothermia and hypotension were not associated with mortality [6]. However, Phua et al [7] found that each minor criterion was predictive of mortality and that the presence of PaO 2 /FiO 2 ≤ 250 mm Hg and confusion had the strongest association with mortality.…”

Section: Introductionmentioning

confidence: 73%

Mortality among severe community-acquired pneumonia patients depends on combinations of 2007 IDSA/ATS minor criteria

Guo

Song

et al. 2015

International Journal of Infectious Diseases

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Section: Introductionmentioning

confidence: 73%

Mortality among severe community-acquired pneumonia patients depends on combinations of 2007 IDSA/ATS minor criteria

Guo

Song

et al. 2015

International Journal of Infectious Diseases

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“…PHUA et al [5] found that each minor criterion was predictive of mortality and that the presence of PaO 2 /FiO 2 f250 mmHg and confusion had the strongest association with mortality. Furthermore, GUO et al [8] showed that minor criteria of the IDSA/ATS criteria for severe CAP were of unequal weight in predicting mortality. They concluded that PaO 2 /FiO 2 f250 mmHg, confusion and uraemia were most strongly associated with mortality, and that an association between leukopenia, hypothermia and hypotension and mortality could not be demonstrated [8].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, GUO et al [8] showed that minor criteria of the IDSA/ATS criteria for severe CAP were of unequal weight in predicting mortality. They concluded that PaO 2 /FiO 2 f250 mmHg, confusion and uraemia were most strongly associated with mortality, and that an association between leukopenia, hypothermia and hypotension and mortality could not be demonstrated [8]. Our analysis suggests that no predictors were significantly or consistently associated with a greater risk compared with the others, showing the value of a meta-analysis approach where individual study results are conflicting.…”

Section: Discussionmentioning

confidence: 99%

“…The IDSA/ATS criteria have now been validated for prediction of 30-day mortality, ICU admission and requirement for subsequent mechanical ventilation or vasopressor (MV/VS) use in several countries [4][5][6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

“…Unlike other severity scores, which were derived from independent predictors in multivariate analysis, the minor criteria were selected by expert opinion and their individual components have not been separately validated [1]. It has been suggested that some criteria may be stronger predictors than others, or that some criteria may be noncontributory to the overall score [1,7,8]. In addition, the 2007 guidelines specifically requested that a group of additional predictors, such as acidosis, hypoglycaemia and liver cirrhosis, be tested by adding to or substituting the existing criteria to determine whether they improve its accuracy [1].…”

Section: Introductionmentioning

confidence: 99%

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Simplification of the IDSA/ATS criteria for severe CAP using meta-analysis and observational data

Salih

Schembri

Chalmers

2013

European Respiratory Journal

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The 2007 Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) guidelines proposed ''minor'' criteria to predict intensive care unit (ICU) admission in patients with community-acquired pneumonia. These criteria were based on expert opinion. Consequently, the authors of the guidelines asked investigators to determine whether the score could be simplified by excluding noncontributory variables.Each IDSA/ATS minor criterion was validated using a random effects meta-analysis of seven studies. Variables present in ,5% of cases or that were nonsignificantly associated with mortality/ICU admission were excluded. A simplified score excluding these variables was tested for prediction of mortality and ICU admission in an established database. Prediction was assessed using the area under the receiver operator characteristic curve (AUC).Leukopenia (,4000 cells?mm -3 ), thrombocytopenia (,100 000 cells?mm -3 ) and hypothermia ,36uC occurred in ,5% of cases. A simplified score excluding these variables was performed similarly for prediction of mortality, AUC 0.77 (95% CI 0.73-0.81) versus 0.78 (95% CI 0.74-0.82) (p50.9) and intensive care unit admission, AUC 0.85 (95% CI 0.82-0.87) versus 0.85 (95% CI 0.82-0.88) (p50.9). Additional predictors suggested by the IDSA/ATS were associated with mortality and ICU admission, but only incorporating acidosis (pH ,7.35) altered the AUC (0.82 (95% CI 0.78-0.86) (p50.6) for mortality and 0.86 (95% CI 0.82-0.88) (p50.8) for ICU admission). No improvements were statistically significant.The IDSA/ATS criteria can be simplified by removing three infrequent variables. @ERSpublicationsThe IDSA/ATS criteria can be simplified by removing three infrequent variables

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CURB-65 score predicted mortality in community-acquired pneumonia better than IDSA/ATS minor criteria in a low-mortality-rate setting

Guo

Zhong

et al. 2012

Eur J Clin Microbiol Infect Dis

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The CURB-65 scoring system performs well at identifying patients with pneumonia who have a low risk of death. Whether it predicts mortality in community-acquired pneumonia (CAP) better than the 2007 Infectious Disease Society of America (IDSA)/American Thoracic Society (ATS) minor criteria in low-mortality-rate settings is not clear. The purpose of this study was to determine the hypothesis.A total of 1,230 adult inpatients admitted to our hospital from 2005 to 2009 for CAP were reviewed retrospectively.The hospital mortality was 1.3 %. Percentage mortality increased significantly with CURB-65 score and the increasing number of IDSA/ATS minor criteria present. The number of CURB-65 criteria or IDSA/ATS minor criteria present had significant increased odds ratios for mortality of 7.547 and 2.711, respectively. The sensitivities of a CURB-65 score of ≥ 3 and the presence of ≥ 3 minor criteria in predicting mortality was 25 % and 37.5 %, which increased to 75 % and 62.5 %, while the cut-off values reduced to ≥ 2 criteria, respectively. The area under the receiver operating characteristic curve for CURB-65 was greater than the corresponding area for IDSA/ATS minor criteria in predicting hospital mortality (0.915 vs. 0.805, p = 0.0091).CURB-65 score predicted hospital mortality better than IDSA/ATS minor criteria, and a CURB-65 score of ≥ 2 or the presence of ≥ 2 minor criteria might be more valuable cut-off values for "severe" CAP in a low-mortality-rate setting.

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Weight of the IDSA/ATS minor criteria for severe community-acquired pneumonia

Abstract: The individual 2007 IDSA/ATS minor criteria for severe CAP were of unequal weight in predicting hospital mortality, SOFA scores, hospital LOS, and costs.

Cited by 19 publications

References 21 publications

Mortality among severe community-acquired pneumonia patients depends on combinations of 2007 IDSA/ATS minor criteria

Mortality among severe community-acquired pneumonia patients depends on combinations of 2007 IDSA/ATS minor criteria

Simplification of the IDSA/ATS criteria for severe CAP using meta-analysis and observational data

CURB-65 score predicted mortality in community-acquired pneumonia better than IDSA/ATS minor criteria in a low-mortality-rate setting

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