A rapid staging system for predicting mortality from HIV-associated community-acquired pneumonia

Ahsan M. Arozullah, Jorge Parada, Charles L. Bennett, Maria Deloria Knoll, Joan S. Chmiel, Laura Phan, Paul R. Yarnold

Research output: Contribution to journalArticle

Abstract

Study objective: Community-acquired pneumonia (CAP) accounts for an increasing proportion of the pulmonary infections in individuals with HIV infection. During the mid-1990s, hospital mortality rates for HIV-associated CAP ranged from 0 to 28%. While hospital differences in case mix may account for mortality rate variation, few methods to evaluate illness severity for HIV-associated CAP have been reported previously. The study objective was to develop a staging system for categorizing mortality risk of patients with HIV-associated CAP using information available prior to hospital admission. Design/setting/patients: Retrospective medical records review of 1,415 patients hospitalized with HIV-associated CAP from 1995 to 1997 at 86 hospitals in seven metropolitan areas. Measurements: In-patient mortality rate. Results: Hierarchically optimal classification tree analysis was used to develop a preadmission staging system for predicting inpatient mortality. The overall inpatient mortality rate was 9.1%. The significant predictors of mortality included the presence of neurologic symptoms, respiratory rate ≥ 25 breaths/min, and creatinine > 1.2 mg/dL. The model identified a five-category staging system, with the mortality rate increasing by stage: 2.3% for stage 1, 5.8% for stage 2, 12.9% for stage 3, 22.0% for stage 4, and 40.5% for stage 5. The classification accuracy of the model was 85.2%. Conclusions: Our staging system categorizes inpatient mortality risk for patients with HIV-associated CAP using three routinely available variables. The staging system may be useful for guiding clinical decisions about the intensity of patient care and for case-mix adjustment in future studies addressing variation in hospital mortality rates.

Original languageEnglish (US)
Pages (from-to)1151-1160
Number of pages10
JournalChest
Volume123
Issue number4
DOIs
StatePublished - Apr 1 2003
Externally publishedYes

Fingerprint

Pneumonia
HIV
Mortality
Inpatients
Hospital Mortality
Risk Adjustment
Diagnosis-Related Groups
Respiratory Rate
Neurologic Manifestations
HIV Infections
Medical Records
Creatinine
Patient Care
Lung
Infection

Keywords

  • Community-acquired pneumonia
  • HIV
  • Hospital mortality

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Arozullah, A. M., Parada, J., Bennett, C. L., Knoll, M. D., Chmiel, J. S., Phan, L., & Yarnold, P. R. (2003). A rapid staging system for predicting mortality from HIV-associated community-acquired pneumonia. Chest, 123(4), 1151-1160. https://doi.org/10.1378/chest.123.4.1151

A rapid staging system for predicting mortality from HIV-associated community-acquired pneumonia. / Arozullah, Ahsan M.; Parada, Jorge; Bennett, Charles L.; Knoll, Maria Deloria; Chmiel, Joan S.; Phan, Laura; Yarnold, Paul R.

In: Chest, Vol. 123, No. 4, 01.04.2003, p. 1151-1160.

Research output: Contribution to journalArticle

Arozullah, AM, Parada, J, Bennett, CL, Knoll, MD, Chmiel, JS, Phan, L & Yarnold, PR 2003, 'A rapid staging system for predicting mortality from HIV-associated community-acquired pneumonia', Chest, vol. 123, no. 4, pp. 1151-1160. https://doi.org/10.1378/chest.123.4.1151
Arozullah, Ahsan M. ; Parada, Jorge ; Bennett, Charles L. ; Knoll, Maria Deloria ; Chmiel, Joan S. ; Phan, Laura ; Yarnold, Paul R. / A rapid staging system for predicting mortality from HIV-associated community-acquired pneumonia. In: Chest. 2003 ; Vol. 123, No. 4. pp. 1151-1160.
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abstract = "Study objective: Community-acquired pneumonia (CAP) accounts for an increasing proportion of the pulmonary infections in individuals with HIV infection. During the mid-1990s, hospital mortality rates for HIV-associated CAP ranged from 0 to 28{\%}. While hospital differences in case mix may account for mortality rate variation, few methods to evaluate illness severity for HIV-associated CAP have been reported previously. The study objective was to develop a staging system for categorizing mortality risk of patients with HIV-associated CAP using information available prior to hospital admission. Design/setting/patients: Retrospective medical records review of 1,415 patients hospitalized with HIV-associated CAP from 1995 to 1997 at 86 hospitals in seven metropolitan areas. Measurements: In-patient mortality rate. Results: Hierarchically optimal classification tree analysis was used to develop a preadmission staging system for predicting inpatient mortality. The overall inpatient mortality rate was 9.1{\%}. The significant predictors of mortality included the presence of neurologic symptoms, respiratory rate ≥ 25 breaths/min, and creatinine > 1.2 mg/dL. The model identified a five-category staging system, with the mortality rate increasing by stage: 2.3{\%} for stage 1, 5.8{\%} for stage 2, 12.9{\%} for stage 3, 22.0{\%} for stage 4, and 40.5{\%} for stage 5. The classification accuracy of the model was 85.2{\%}. Conclusions: Our staging system categorizes inpatient mortality risk for patients with HIV-associated CAP using three routinely available variables. The staging system may be useful for guiding clinical decisions about the intensity of patient care and for case-mix adjustment in future studies addressing variation in hospital mortality rates.",
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