Am. J. Respir. Crit. Care Med., Volume 162, Number 6, December 2000, 2063-2068

Community-Acquired Bacterial Pneumonia in Human Immunodeficiency Virus-Infected Patients
Validation of Severity Criteria

ELISA CORDERO, JERÓNIMO PACHÓN, ANTONIO RIVERO, JOSÉ A. GIRÓN, JESÚS GÓMEZ-MATEOS, MARÍA D. MERINO, MANUEL TORRES-TORTOSA, MERCEDES GONZÁLEZ-SERRANO, LUIS ALIAGA, ANTONIO COLLADO, JOSÉ HERNÁNDEZ-QUERO, ANTONIO BARRERA, and ENRIQUE NUÑO, for The Grupo Andaluz Para el Estudio de las Enfermedades Infecciosas

Infectious Diseases Services, Virgen del Rocío University Hospital, and Valme University Hospital, Seville; Virgen de la Victoria University Hospital, Málaga; Axarquia Clinical Hospital, Vélez-Málaga, Málaga; Puerta del Mar University Hospital, Cádiz; Punta de Europa Hospital, Algeciras, La Línea de la Concepción S.A.S. Hospital, and Jerez de la Frontera S.A.S. Hospital, Cádiz; Juan Ramón Jiménez Hospital, Huelva; Virgen de las Nieves University Hospital, and Granada Clinical Hospital, Granada; and Torrecárdenas Hospital, Almería, Spain

Severity criteria for community-acquired pneumonia (CAP) have always excluded patients with human immunodeficiency virus (HIV) infection. A 1-yr, multicenter, prospective observational study of HIV-infected patients with bacterial CAP was done to validate the criteria used in the American Thoracic Society (ATS) guidelines for CAP, and to determine the prognosis-associated factors in the HIV-infected population with bacterial CAP. Overall, 355 cases were included, with an attributable mortality of 9.3%. Patients who met the ATS criteria had a longer hospital stay (p = 0.01), longer duration of fever (p < 0.001), and higher attributable mortality (13.1% versus 3.5%, p = 0.02) than those who did not. Three factors were independently related to mortality: CD4⁺ cell count < 100/µl, radiologic progression of disease, and shock. Pleural effusion, cavities, and/or multilobar infiltrates at admission were independently associated with radiologic progression. A prognostic rule based on the five criteria of shock, CD4⁺ cell count < 100/µl, pleural effusion, cavities, and multilobar infiltrates had a high negative predictive value for mortality (97.1%). The attributable mortality for severe pneumonia was 11.3%, as compared with 1.3% for nonsevere disease (p = 0.008). The ATS severity criteria are valid in HIV-infected patients with bacterial CAP. Our study provides the basis for identification of patients who may require hospitalization determined by clinical judgment and the five clinical criteria of shock, a CD4⁺ cell count < 100/µl, pleural effusion, cavities, and multilobar involvement. These prognostic factors should be validated in independent cohort studies.

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