Mortality among severe community-acquired pneumonia patients depends on combinations of 2007 IDSA/ATS minor criteria

Int J Infect Dis. 2015 Sep;38:141-5. doi: 10.1016/j.ijid.2015.07.026. Epub 2015 Aug 6.


Objectives: The individual 2007 Infectious Disease Society of America (IDSA)/American Thoracic Society (ATS) minor criteria for severe community-acquired pneumonia (CAP) are of unequal weight in predicting mortality. It is not clear whether the combinations of predictive findings might imply diverse severities or different mortalities.

Methods: A prospective two centre cohort study was performed of 385 severe CAP patients fulfilling three or more IDSA/ATS minor criteria amongst 1430 patients.

Results: Hospital mortality rose sharply from 5.7%, 9.9%, and 16.5%, respectively, for patients with none of three predictive findings most strongly associated to mortality (PaO2/FiO2 ≤ 250mm Hg, confusion and uraemia), one of those, and two of those to 38.6% for patients with all those (p<0.001). The number of three predictive findings present had a significantly increased odds ratio for mortality of 2.796 (p<0.001), and had the degree of positive association with sequential organ failure assessment scores at 72hours, incurring significantly longer hospital stay and higher costs.

Conclusions: Different combinations of 2007 IDSA/ATS minor criteria for severe CAP were associated to diverse severities and different mortalities. The combination of PaO2/FiO2 ≤ 250mm Hg, confusion and uraemia predicted more severity and higher mortality compared with others.

Keywords: Combination; Minor criteria; Mortality; Severe community-acquired pneumonia.

Publication types

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

MeSH terms

  • Aged
  • Cohort Studies
  • Community-Acquired Infections / mortality*
  • Female
  • Hospital Mortality
  • Humans
  • Male
  • Middle Aged
  • Pneumonia / mortality*
  • Prospective Studies
  • Severity of Illness Index