Wednesday March 25, 2009
PIRO Score: Does it help In VAP

Background: No 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.

Methods: A 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.

A simple, four-variable VAP PIRO score was obtained at VAP onset.

Score: Each point for below 4

1. Co morbidities = COPD, immunocompromise, heart failure, cirrhosis, or chronic renal failure
2. Insult = Bacteremia
3. Response = Systolic BP less than 90 mm hg
4. Organ dysfunction = ARDS

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.

Results:

• VAP PIRO score was associated with higher risk of death in Cox regression analysis in the high-risk group and the very-high-risk group
• 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 and duration of mechanical ventilation
  

Conclusions: VAP 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.

Reference: click to get abstract

Lisoba T, Diaz R, Sa-borges M, et al. A Tool for Predicting ICU Mortality and Health-Care Resources Use in Ventilator-Associated Pneumonia. Chest. 2008; 134:1208-1216