Predicting death in patients hospitalized for community-acquired pneumonia

Ann Intern Med. 1991 Sep 15;115(6):428-36. doi: 10.7326/0003-4819-115-6-428.


Objective: To validate a previously reported discriminant rule for predicting mortality in adult patients with primary community-acquired pneumonia and to determine which factors available at hospital admission predict a fatal outcome among such patients.

Design: Historical cohort study.

Setting: University hospital.

Patients: Adults admitted to the hospital for community-acquired pneumonia.

Measurements: Using stepwise logistic regression, we analyzed prognostic factors (data available at admission and recorded in the medical record) that showed a univariate association with mortality. The predictive values of three discriminant rules were measured to validate the results of a previous study.

Main results: Of 245 patients, 20 (8.2%) died. Of 42 prognostic factors identified in previous studies, 8 were associated with mortality, but only a respiratory rate of 30/min or more, a diastolic blood pressure of 60 mm Hg or less, and a blood urea nitrogen of more than 7 mmol/L remained predictive in the multivariate analysis. A discriminant rule composed of these three variables was 70% sensitive and 84% specific in predicting mortality, yielding an overall accuracy of 82%.

Conclusion: Tachypnea, diastolic hypotension, and an elevated blood urea nitrogen were independently associated with death from pneumonia in our study, confirming the value of a previously reported discriminant rule from the British Thoracic Society. This rule may be useful in triage decisions because it identifies high-risk patients who may benefit from special medical attention.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / therapeutic use
  • Blood Pressure
  • Blood Urea Nitrogen
  • Hospitalization
  • Humans
  • Middle Aged
  • Pneumonia / blood
  • Pneumonia / drug therapy
  • Pneumonia / mortality*
  • Pneumonia / physiopathology
  • Predictive Value of Tests
  • Prognosis
  • Regression Analysis
  • Respiration
  • Retrospective Studies
  • Survival Analysis
  • Virginia


  • Anti-Bacterial Agents