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poor prognostic factors & criteria for severe pneumonia
Poor prognostic factors:
1) general
a) age > 65 years
b) presence of co-existing illness
- chronic obstructive pulmonary disease (COPD)
- diabetes mellitus
- acute or chronic renal failure
- congestive heart failure
- cirrhosis
- recent hospitalization
c) evidence of aspiration
d) altered level of consciousness
e) splenectomy
f) malnutrition
g) alcohol or other drug use
h) mechanical ventilation
2) physical findings
- respiratory rate > 30 breaths/minute
- systolic blood pressure (BP) < 90 or diastolic BP < 60
- temperature > 38.3 C
- extrapulmonary sites of infection
3) laboratory findings
- WBC < 4000/mm3 or > 30,000/mm3
- absolute neutrophil count < 1000/mm3
- pO2 < 60 mm Hg or pCO2 > 50 mm Hg on room air
- serum creatinine > 1.2 mg/dL or urea nitrogen > 20 mg/dL
- hemoglobin < 9 g/dL or hematocrit < 30%
- metabolic acidosis
- evidence of disseminated intravascular coagulation (DIC)
4) chest X-ray
- multiple lobe involvement
- cavitary disease
- pleural effusion
- significant change over short interval
5) social
- homeless
- no responsible caregiver
- failure to follow-up
- no telephone
- no transportation
- inability to afford medical care
* Criteria for severe pneumonia:
1) respiratory rate > 30/min
2) impending respiratory failure
3) mechanical ventilation
4) bilateral or multilobe involvement
5) progression on chest X-ray > 50% in 48 hours
6) shock
7) need for vasopressors
8) acute renal failure or oliguria
Related
pneumonia (PNA)
prognosis