Title:Health-Care Associated Pneumonia (HCAP): Identification of Low and High-Risk Patients
VOLUME: 11 ISSUE: 3
Author(s):John Abisheganaden, Yew Y. Ding, Wai F. Chong, Bee H. Heng, Akash Verma and Taw K. Lim
Affiliation:Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433.
Keywords:Antibiotic, co-morbidity, pneumonia, severity.
Abstract:Objective: To identify low and high-risk sub-groups of patients admitted for Health-Care
Associated Pneumonia (HCAP).
Methods: We conducted a retrospective study of patients hospitalized for HCAP. Demographic data,
co-morbidity, clinical features, laboratory findings, and chest radiographic changes were used to
construct logistic regression models that employed Pneumonia Severity Index (PSI) or CURB-65 to
predict 30-day mortality and guide the creation of low- and high-risk sub-groups.
Results: Among 798 hospital episodes for HCAP, the median age was 80 years and 67. 9% of patients had pre-morbid
ambulation impairment. The 30-day mortality was 35.3 %. For the subgroup (3.5%) of patients with PSI class II with no
pre-morbid ambulation impairment, 30-day mortality was 0%. At the other end, CURB-65 score of 4 or 5 with pre-morbid
ambulation impairment identified a subgroup (3.0%) of patients with 30-day mortality of 83.3%.
Conclusion: Combining either PSI or CURB-65 with pre-morbid ambulation status, we were able to identify very low and
high-risk mortality subgroups among HCAP patients. In the appropriate clinical context, early discharge may be
considered for the very low risk subgroup, while de-escalation of antibiotic therapy and symptom palliation may be
considered for the very high-risk subgroup.
