poor prognostic factors & criteria for severe pneumonia

Introduction

Poor prognostic factors:

• general
  • age > 65 years
  • presence of co-existing illness
    • chronic obstructive pulmonary disease (COPD)
    • diabetes mellitus
    • acute or chronic renal failure
    • congestive heart failure
    • cirrhosis
    • recent hospitalization
  • evidence of aspiration
  • altered level of consciousness
  • splenectomy
  • malnutrition
  • alcohol or other drug use
  • mechanical ventilation
• physical findings
  • respiratory rate > 30 breaths/minute
  • systolic blood pressure (BP) < 90 or diastolic BP < 60
  • temperature > 38.3 C
  • extrapulmonary sites of infection
• laboratory findings
  • WBC < 4000/mm3 or > 30,000/mm3
  • absolute neutrophil count < 1000/mm3
  • pO2 < 60 mm Hg or pCO2 > 50 mm Hg on room air
  • serum creatinine > 1.2 mg/dL or urea nitrogen > 20 mg/dL
  • hemoglobin < 9 g/dL or hematocrit < 30%
  • metabolic acidosis
  • evidence of disseminated intravascular coagulation (DIC)
• chest X-ray
  • multiple lobe involvement
  • cavitary disease
  • pleural effusion
  • significant change over short interval
• social
  • homeless
  • no responsible caregiver
  • failure to follow-up
  • no telephone
  • no transportation
  • inability to afford medical care

* Criteria for severe pneumonia:

• respiratory rate > 30/min
• impending respiratory failure
• mechanical ventilation
• bilateral or multilobe involvement
• progression on chest X-ray > 50% in 48 hours
• shock
• need for vasopressors
• acute renal failure or oliguria

Additional terms

• pneumonia (PNA)
• prognosis