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Pneumonia Severity Index (PSI/PORT)

Pulmonology

Pneumonia Severity Index (PSI/PORT)

Estimates mortality for Community-Acquired Pneumonia (CAP).

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Parameters

Age*years

years

Biological Sex*

Male

Female (-10 points)

Nursing home resident (+10)

Yes, this condition applies to the patient

Neoplastic disease (active/within 1 year) (+30)

Yes, this condition applies to the patient

Liver disease (cirrhosis/active) (+20)

Yes, this condition applies to the patient

Congestive heart failure (+10)

Yes, this condition applies to the patient

Cerebrovascular disease (Stroke/TIA) (+10)

Yes, this condition applies to the patient

Renal disease (BUN > 30 or Cr > 1.2 or ESRD) (+10)

Yes, this condition applies to the patient

Altered mental status (+20)

Yes, this condition applies to the patient

Respiratory rate ≥ 30 breaths/min (+20)

Yes, this condition applies to the patient

Systolic blood pressure < 90 mmHg (+20)

Yes, this condition applies to the patient

Temperature < 35°C (95°F) or ≥ 40°C (104°F) (+15)

Yes, this condition applies to the patient

Pulse ≥ 125 beats/min (+10)

Yes, this condition applies to the patient

Arterial pH < 7.35 (+30)

Yes, this condition applies to the patient

BUN ≥ 30 mg/dL (11 mmol/L) (+20)

Yes, this condition applies to the patient

Sodium < 130 mEq/L (+20)

Yes, this condition applies to the patient

Glucose ≥ 250 mg/dL (14 mmol/L) (+10)

Yes, this condition applies to the patient

Hematocrit < 30% (+10)

Yes, this condition applies to the patient

Arterial PO2 < 60 mmHg or SpO2 < 90% (+10)

Yes, this condition applies to the patient

Pleural effusion on x-ray (+10)

Yes, this condition applies to the patient

Pneumonia Severity Index (PSI/PORT) Result

FormulaBase points = Age (years). Subtract 10 if female. Add points for comorbidities, exam abnormalities, and lab derivations.

Clinical Pearls

Provides more granular risk stratification than CURB-65. The IDSA/ATS guidelines recommend the PSI over CURB-65 for determining site of care in CAP.

Limitations

Heavily weighted by age, which may underestimate risk in young patients with severe hypoxemia or sepsis, and overestimate risk in healthy elderly patients. Requires extensive lab testing.

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