The Ventilator-Associated Pneumonia PIRO Score : A Tool for Predicting ICU Mortality and Health-Care Resources Use in Ventilator-Associated Pneumonia

BackgroundNo score is available to assess severity and stratify mortality risk in ventilator-associated pneumonia (VAP). Our objective was to develop a severity assessment tool for VAP patients.MethodsA prospective, observational, cohort study was performed including 441 patients with VAP in three multidisciplinary ICUs. Multivariate logistic regression was performed to identify variables independently associated with ICU mortality. Results were converted into a four-variable score based on the PIRO (predisposition, insult, response, organ dysfunction) concept for ICU mortality risk stratification in VAP patients.ResultsComorbidities (COPD, immunocompromise, heart failure, cirrhosis, or chronic renal failure); bacteremia; systolic BP < 90 mm Hg; and ARDS. A simple, four-variable VAP PIRO score was obtained at VAP onset. Mortality varied significantly according to VAP PIRO score (p < 0.001). On the basis of observed mortality for each VAP PIRO score, patients were stratified into three levels of risk: (1) mild, 0 to 1 points; (2) high, 2 points; (3) very high, 3 to 4 points. VAP PIRO score was associated with higher risk of death in Cox regression analysis in the high-risk group (hazard ratio, 2.14; 95% confidence interval [CI], 1.19 to 3.86) and the very-high-risk group (hazard ratio, 4.63; 95% confidence interval, 2.68 to 7.99). Moreover, medical resource use after VAP diagnosis was higher in high-risk and very-high-risk levels compared to patients at mild risk, evaluated using length of ICU stay (mean ± SD, 22.0 ± 10.6 d vs 18.7 ± 12.8 d, p < 0.05) and duration of mechanical ventilation (18.3 ± 10.1 d vs 15.1 ± 11.5 d, p < 0.05).ConclusionsVAP PIRO score is a simple, practical clinical tool for predicting ICU mortality and health-care resources use that is likely to assist clinicians in determining VAP severity.