Table 5Adjusted coefficients and odd ratios for admission to ICU within three days of presentation and points selleck chem inhibitor assigned in the predictive modelRisk of early admission to the ICUThe risk of early admission to the ICU (REA-ICU) score ranged from 0 to 17 and was stratified into four risk classes (REA-ICU index; Table Table6).6). In the derivation cohort the rate of ICU admission on days 1 to 3 ranged from 1.1% for risk class I to 27.1% for risk class IV and 28-day mortality ranged from 1.2 to 15.1%. Similar rates were observed in the validation cohort. In risk class I, five patients (not admitted to ICU) died within three days of ED presentation. The risk class I patients accounted for 2510 of 4593 (54.6%) and 1099 of 1967 (55.9%) patients, respectively, in the derivation and validation cohorts, with 27 out of 2510 (1.

1%) and 14 out of 1099 (1.3%) of these patients admitted to the ICU, respectively. Among these 41 patients, 10 were classified as high-risk using the Pneumonia Severity Index (PSI) and none subsequently died.Table 6Population and outcomes stratification according to the risk of early ICU admission index (REA-ICU index) of patients with community acquired pneumoniaThe area under the ROC curves for the REA-ICU score was 0.80 (95% confidence interval (CI) = 0.77 to 0.83) and 0.80 (95% CI = 0.76 to 0.84) in the derivation and validation cohorts, respectively.The risk of admission to the ICU on days 1 to 3 increased significantly from risk class I to risk class IV within each of the four original cohorts (P < 0.001 for each cohort).

The area under the ROC curve of the score for predicting admission to an ICU on days 1 to 3 ranged from 0.76 (95% CI = 0.72 to 0.90) in the EDCAP cohort to 0.82 (95% CI = 0.85 to 0.90) in the Pneumocom-2 cohort.The REA-ICU score yielded a higher area under the ROC curve than the PSI (0.75, 95% CI = 0.73 to 0.78), CURB-65 (0.69, 95% CI = 0.66 to 0.72) and Espana Severe CAP (SCAP) (0.74, 95% CI = 0.71 to 0.76) for predicting ICU admission on days 1 to 3 for patients not requiring immediate circulatory or ventilatory support (P < 0.001 for all pairwise comparisons involving the REA-ICU score).DiscussionIn this study, we identified 11 baseline characteristics that were independently associated with ICU admission on days 1 to 3 in a broad range of patients presenting with CAP and no obvious reason for immediate ICU admission (i.e. not requiring immediate respiratory or circulatory support). These characteristics included male gender, age younger than 80 years, comorbid Entinostat condition of 1 or higher, tachypnoea, tachycardia, leukopenia or leukocytosis, multilobar infiltrates or pleural effusion, hypoxaemia, acidosis, hyperuraemia and hyponatraemia.