The “PIRO” classification system was developed to stratify sepsis patients based on their PREDISPOSING conditions, nature/extent of the INSULT, nature/extent of the host RESPONSE, and degree of ORGAN dysfunction. This study sought to identify the predictive power of a “PIRO” score for ICU patients with CAP, compared to both the APACHE II score and the 2007 ATS/IDSA pneumonia severity criteria. They found the 8 point PIRO score predicted 28 day mortality better than either, with an AUC of 0.88 (1 point each for COPD/immunocompromise, age>70, bacteremia, multilobar involvement, shock, hypoxemia, renal failure, or ARDS) (abstract). Mortality ranged from 4% (score 0-2) to 76% (score 5-8). This easy to calculate score can be very useful in stratifying risk in CAP patients admitted to the ICU.
Dr. Scheurer is a clinical hospitalist and the Medical Director of Quality and Safety at the Medical University of South Carolina in Charleston, South Carolina, and is Assistant Professor of Medicine. She is a graduate of the University of Tennessee College of Medicine, completed her residency at Duke University, and completed her Masters in Clinical Research at the Medical University of South Carolina. She also serves as the Web Editor and Physician Advisor for the Society of Hospital Medicine.