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Pneumonia Severity Index (PSI) for Community Acquired Pneumonia

¹ Definitions of comorbid illnesses

Neoplastic disease: any cancer except basal- or squamous-cell cancer of the skin that was active at the time of presentation or diagnosed within one year of presentation.
Liver disease: a clinical or histologic diagnosis of cirrhosis or another form of chronic liver disease, such as chronic active hepatitis.
Congestive heart failure: systolic or diastolic ventricular dysfunction documented by history, physical examination, and chest radiograph, echocardiogram, multiple gated acquisition scan, or left ventriculogram.
Cerebrovascular disease: a clinical diagnosis of stroke or transient ischemic attack or stroke documented by magnetic resonance imaging or computed tomography.
Renal disease: a history of chronic renal disease or abnormal blood urea nitrogen and creatinine concentrations documented in the medical record.

Formula

Risk class interpretation (30-day mortality, observed in validation cohorts)

Class I:	0.1% Mortality. Candidates for outpatient treatment.
Class II (<= 70 Points):	0.6% Mortality. Candidates for outpatient treatment.
Class III (71–90 Points):	0.9–2.8% Mortality. Outpatient treatment vs brief inpatient observation (based on clinical judgement).
Class IV (91–130 Points):	8.2–9.3% Mortality. Inpatient care.
Class V (131–395 Points):	27.0–29.2% Mortality. Inpatient care.

Demographic factors
Age	years
Sex	Male Female
Nursing home resident	Yes No
Comorbid illnesses¹
¹ Definitions of comorbid illnesses Neoplastic disease: any cancer except basal- or squamous-cell cancer of the skin that was active at the time of presentation or diagnosed within one year of presentation. Liver disease: a clinical or histologic diagnosis of cirrhosis or another form of chronic liver disease, such as chronic active hepatitis. Congestive heart failure: systolic or diastolic ventricular dysfunction documented by history, physical examination, and chest radiograph, echocardiogram, multiple gated acquisition scan, or left ventriculogram. Cerebrovascular disease: a clinical diagnosis of stroke or transient ischemic attack or stroke documented by magnetic resonance imaging or computed tomography. Renal disease: a history of chronic renal disease or abnormal blood urea nitrogen and creatinine concentrations documented in the medical record.
Neoplastic disease	Yes No
Liver disease	Yes No
Congestive heart failure	Yes No
Cerebrovascular disease	Yes No
Renal disease	Yes No
Physical examination findings
Altered mental status²	Yes No
² Altered mental status is defined as disorientation with respect to person, place, or time that is not known to be chronic, stupor, or coma.
Respiratory rate >= 30/minute	Yes No
Systolic blood pressure < 90 mmHg	Yes No
Temperature < 35^oC (95^oF) or >= 40^oC (103.8^oF)	Yes No
Pulse >= 125/minute	Yes No
Laboratory and radiographic findings
Arterial pH < 7.35	Yes No
Blood urea nitrogen >= 30 mg/dL (11 mmol/L)	Yes No
Sodium < 130 mEq/L	Yes No
Glucose >= 250 mg/dL (14 mmol/L)	Yes No
Hematocrit < 30%	Yes No
Partial pressure of arterial oxygen < 60 mmHg³	Yes No
³In the Pneumonia Patient Outcome Research Team (PORT) cohort study, an oxygen saturation value < 90% on pulse oximetry or intubation before admission was also considered abnormal.
Pleural effusion (on x-ray)	Yes No
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Total criteria point count:
Class:
Mortality:	%

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Pneumonia Severity Index (PSI) for Community Acquired Pneumonia