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

Chest. 2003 Apr;123(4):1151-60. doi: 10.1378/chest.123.4.1151.


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 > or = 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.

Publication types

  • Multicenter Study
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • AIDS-Related Opportunistic Infections / mortality*
  • Adult
  • Community-Acquired Infections
  • Female
  • HIV Infections / mortality*
  • Hospital Mortality*
  • Humans
  • Male
  • Models, Statistical
  • Multivariate Analysis
  • Pneumonia, Viral / mortality*
  • Retrospective Studies
  • Risk Assessment
  • Severity of Illness Index*