Predictors of Inpatient Mortality Among HIV Patients with Community-Acquired Pneumonia

Arozullah AM, Yarnold PR, Deloriaknoll M. Predictors of Inpatient Mortality Among HIV Patients with Community-Acquired Pneumonia. Paper presented at: Society of General Internal Medicine Annual Meeting; 2001 May 1; San Diego, CA.

PURPOSE: Pulmonary infections, including bacterial pneumonia, cause significant morbidity and mortality for patients infected with HIV. The purpose of this project was to determine the predictors of inpatient mortality among HIV patients with community-acquired pneumonia admitted in the early highly active antiretroviral therapy era, between 1995-1997.METHODS: Trained abstractors performed retrospective chart reviews of hospitalized HIV patients diagnosed or suspected of having community-acquired pneumonia, who were admitted between 1995-1997 at 86 hospitals in 7 geographic areas. We used hierarchically optimal classification tree analysis to develop a pre-admission severity of illness staging system for predicting inpatient mortality.RESULTS: Among HIV patients with confirmed or suspected community-acquired pneumonia (n = 1112), the inpatient mortality rate was 9.5%. Multivariate modeling indicated a 5-category staging based on four predictors (Table 1). Boostrap validity analysis (50% resample) supported the stability of this model.CONCLUSION: Our staging system identifies HIV patients with low, moderate, and high risk of inpatient mortality from community-acquired pneumonia and may be useful for case-mix adjustment while exploring variations in community-acquired pneumonia mortality rates among hospitals and across cities caring for HIV patients.Table 1 Staging system for Predicting Inpatient MortalityStage N(%) Respiratory Albumin Creatinine CD4 Mortality Rate Rate1 456(41.0) 24.5/minute > 2.95 g/dl ------ --- 0.9%2 126(11.3) > 24.5/minute -------- 1.25 mg/dl 50 3.2%3 274(24.7) 24.5/minute 2.95 g/dl -------- --- 10.2%4 97(8.7) > 24.5/minute -------- 1.25 mg/dl < 50 14.4%5 159(14.3) > 24.5/minute -------- > 1.25 mg/dl --- 35.2%