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The Long-term Pneumonia Mortality Index: an international multicenter derivation and validation study for patients with community-acquired pneumonia

Fecha de publicación:

Autores de IIS La Fe

Participantes ajenos a IIS La Fe

  • Hervás, D
  • Knox, D
  • Carr, J
  • Barten-Neiner, G
  • Rohde, G
  • Pletz, MW
  • Rupp, J
  • Witzenrath, M
  • Dean, NC

Grupos

Abstract

Rationale Long-term mortality after hospital discharge in community-acquired pneumonia (CAP) is a neglected issue. A validated, accurate score predicting mortality is needed.Objective To derive and validate the Long-term Pneumonia Mortality Index (L-PMI).Methods L-PMI derivation used data from a Spanish multicenter prospective study on CAP with a 1-year follow-up. A logistic regression model for predicting 1-year mortality risk was developed. Performance of the model was assessed by estimating the area under the receiver operating characteristic curve (AUC). The model was externally validated using 2 independent multicenter CAP cohorts from Germany and the United States (USA), and one COVID-19 pneumonia cohort from Spain. We then derived a score from the model to ease its application.Measurements and Main Results The long-term mortality rate after discharge was 6.3%, 4.4%, 17.4%, and 3.6% in the derivation, CAPNETZ (only 6 months of follow-up), USA, and COVID-19 cohorts, respectively. The L-PMI included age, smoking history, nursing home residency, Charlson Comorbidity Index score, CURB-65 score, use of noninvasive or invasive mechanical ventilation, and in-hospital cardiovascular events. The L-PMI showed high discrimination for mortality in the derivation cohort (AUC, 0.82 [95% CI, 0.78-0.85]). In the validation cohorts, the AUC (95% CI) ranged from 0.78 (0.73-0.83) to 0.75 (0.73-0.77) for the CAPNETZ and USA cohorts, respectively, and 0.88 (0.84-0.93) for the COVID-19 cohort. L-PMI allows classification of patients according to their mortality risk into low-, intermediate-, and high-risk groups.Conclusions The L-PMI is a novel clinical prediction score that identifies pneumonia patients at risk of mortality up to 1 year after discharge.

Datos de la publicación

ISSN/ISSNe:
1073-449X, 1535-4970

AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE  AMER THORACIC SOC

Tipo:
Article
Páginas:
1305-1314
PubMed:
41738235
Factor de Impacto:
5,950 SCImago ℠
Cuartil:
Q1 SCImago ℠

Citas Recibidas en Web of Science: 1

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Keywords

  • pneumonia; long-term; mortality; prediction

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