Adult community-acquired pneumonia in Malaysia: prediction of mortality from severity assessment on admission.

Loh, Li-Cher; Khoo, Sert-Kim; Quah, Soong-Yuen; Visvalingam, Vanitha; Radhakrishnan, Anuradha; Vijayasingham, Pillai; Thayaparan, Tarmizi

OBJECTIVES Prediction of mortality in patients with community-acquired pneumonia (CAP) can be assessed using clinical severity scores on admission to hospital. The clinical benefit of such tools is untested in Asian countries. The aim of this study was to determine the early adverse prognostic factors in patients hospitalized with CAP in Malaysia and to assess the usefulness of the British Thoracic Society (BTS) severity criteria. METHODOLOGY A prospective study was undertaken of all adult patients admitted between August 2002 and March 2003 in an urban-based university teaching hospital. RESULTS One hundred and eight patients (mean +/- SD age 55 +/- 20 years; 58% men) were eligible for the study. Thirteen patients (12%) died in hospital and 95 (88%) survived to hospital discharge. Older age, the presence of chronic illness, severity of comorbidity, reduced oxygen saturation and higher blood urea were associated with mortality during admission. Multivariate logistic regression of these variables identified reduced oxygen saturation as the only independently associated variable. BTS criteria fared poorly in predicting mortality compared with clinical assessment by attending clinicians (36-fold increased risk of death by 'clinical assessment' vs two-threefold by 'BTS criteria'). CONCLUSIONS In hospitalized patients with CAP, certain factors are adversely associated with mortality during admission. Severity criteria validated in specific countries might not be universally applicable.