Fine's index does not predict mortality in patients with severe community-acquired pneumonia admitted to the intensive care unit

Índice de Fine no predice mortalidad en pacientes con neumonía grave adquirida en comunidad que ingresan a cuidado intensivo

Objective: to compare the mortality predicted by Fine's severity index (pneumonia-specific index) and that observed in patients with severe community-acquired pneumonia (CAP) admitted to the intensive care unit.

Frame of reference: intensive care unit of Hospital Santa Clara (Bogotá, Colombia), a third-level university hospital.

Type of study: observational, analytic, bidirectional cohort study for application of prediction rule.

Patients and methods: patients diagnosed with CAP admitted to the ICU between January 1993 and December 1996. Fine’s index was calculated retrospectively (1993) and prospectively (1994-1996). Demographic characteristics, comorbidities, and condition at discharge were extracted from the clinical history. For each group of the classification, mortality was calculated and compared by difference of proportions with that predicted by Fine's index

Results: over the study period, 103 patients were admitted to the ICU with pneumonia as main diagnosis. Most of them (93) were classified into classes III and IV. For classes I and II, expected and observed mortality were similar. For classes III and IV, observed mortality was significantly higher than predicted mortality. The potential reasons and implications of this finding are discussed.

Conclusion: in this group of patients with severe CAP admitted to the ICU, Fine's index failed to correctly predict the evolution of the disease