A Validation and Potential Modification of the Pneumonia Severity Index in Elderly Patients with Community‐Acquired Pneumonia

Abstract

The modified PSI could identify low-risk patients more accurately than the original PSI. In addition, by combining the modified PSI with PS, higher performance was obtained. Such information would aid physicians in clinical decision-making without overestimating the risk for elderly patients with CAP.

Management of community-acquired pneumonia in older adults

“…However, in 144 very elderly patients (80 years old) it was observed that PSI high-risk groups (classes IV and V) did not perform well in discriminating survivors from nonsurvivors (sensitivity 100%, specificity 15%). When only PSI class V was defined as a highrisk group, its specificity was considerably greater, and it retained high sensitivity [Naito et al 2006].…”

“…Many studies have reported the association between mortality and the severity of pneumonia, as expressed by its extension and consequent respiratory failure [Riquelme et al 1997;García-Ordó ñ ez et al 2001;Naito et al 2006;Skull et al 2009]. Another group of prognostic factors for poor outcome is related to an inadequate response to infection, such as septic shock at admission, apyrexia, and altered mental status [Riquelme et al 1997;García-Ordó ñ ez et al 2001;Fernández-Sabé et al 2003].…”

“…Another group of prognostic factors for poor outcome is related to an inadequate response to infection, such as septic shock at admission, apyrexia, and altered mental status [Riquelme et al 1997;García-Ordó ñ ez et al 2001;Fernández-Sabé et al 2003]. The third group of factors related to mortality includes host characteristics: low functional status, bedridden status, poor nutritional status, and passive or active smoking have all been related to poor outcome in elderly patients with CAP [Skull et al 2009;Naito et al 2006;Riquelme et al 1997;Ma et al 2011;Vecchiarino et al 2004].…”

Management-based risk prediction in community-acquired pneumonia by scores and biomarkers

“…From several recent European studies it has been consistently shown that the main drivers of poor prognosis in nursing home patients are: 1) poor functional status due to severe and often multiple comorbidities; and 2) hidden or open treatment restrictions rather than treatment failure due to inadequate therapy of multiresistant or rare pathogens [12,[44][45][46]. Thus, routine assessment of functional status, preferentially defined by a validated score like activities of daily living (o14) or World Health Organization performance status (o3) has been suggested to account for this important patient group more adequately [43,47]. Established risk stratification tools like the CRB-65 and PSI scores work less well in elderly and severely disabled patients, but can be significantly improved by including oxygenation measurement and assessment of functional status [47][48][49][50].…”

“…Thus, routine assessment of functional status, preferentially defined by a validated score like activities of daily living (o14) or World Health Organization performance status (o3) has been suggested to account for this important patient group more adequately [43,47]. Established risk stratification tools like the CRB-65 and PSI scores work less well in elderly and severely disabled patients, but can be significantly improved by including oxygenation measurement and assessment of functional status [47][48][49][50]. A recent population-based study from Germany showed that especially the negative predictive value of the CRB-65 score for mortality in nursing home patients is insufficient as hospital mortality of identified ''low risk'' patients was still about 20%, but prediction could be improved by the evaluation of functional status (''bedridden'') and comorbidities [50].…”