Pneumonia severity index (Port Score)

Use

• Estimates mortality for adult patients with community-acquired pneumonia

Scoring

Pneumonia severity index (Port Score)

Risk Factors	Points
Demographic Factors
Age for men	Age
Age for women	Age -10
Nursing home resident	+10
Coexisting Illnesses
Neoplastic disease (active)	+30
Chronic liver disease	+20
Heart Failure	+10
Cerebrovascular disease	+10
Chronic renal disease	+10
Physical Exam
AMS	+20
RR > 30/min	+20
Sys BP < 90	+20
Temp <35 or >40	+15
Pulse > 125	+10
Lab and xray findings
Arterial pH < 7.35	+30
BUN > 30	+20
Na <130	+20
Glucose > 250	+10
Hematocrit <30%	+10
PaO2 < 60 or SpO2 < 90%	+10
Pleural effusion	+10

Classification

Class	Points	Mortality
I	<51	0.1%
II	51-70	0.6%
III	71-90	0.9%
IV	91-130	9.3%
V	>130	27%

Disposition Pathway

• Classes I and II: consider discharge
• Class III: discharge verus admit based on clinical judgment
• Classes IV and V: consider admission

CURB-65

1. Confusion
2. bUn > 19 mg/dl
3. RR > 30
4. BP < 90 SBP, or < 60 DBP
5. Age > 65

• Approximate 30-day mortalities and Tx considerations
  • +1 --> 3%, outpt tx
  • +2 -->7%, inpt, possible outpt
  • +3 --> 14% inpt, possible ICU
  • +4-5 --> 30% ICU

Prognosis

• Half of patients are still symptomatic at 30 days, with a significant minority of patients experiencing chest pain, malaise or mild dyspnea even 2 to 3 months after treatment
• In adults with CAP whose symptoms have resolved within 5-7 days, it is not recommended to routinely obtain follow-up chest imaging

See Also

• Pneumonia
• Pneumonia (Pathogens)
• Pneumonia (Peds)