Prospective comparison of severity scores for predicting clinically relevant outcomes for patients hospitalized with community-acquired pneumonia.
BACKGROUND
The comparative accuracy and discriminatory power of three validated rules for predicting clinically relevant outcomes other than mortality in patients hospitalized with community-acquired pneumonia (CAP) are unknown.


METHODS
We prospectively compared the newly developed severe community-acquired pneumonia (SCAP) score, pneumonia severity index (PSI), and the British Thoracic Society confusion, urea > 7 mmol/L, respiratory rate > or = 30 breaths/min, BP < 90 mm Hg systolic or < 60 mm Hg diastolic, age > or = 65 years (CURB-65) rule in an internal validation cohort of 1,189 consecutive adult inpatients with CAP from one hospital and an external validation cohort of 671 consecutive adult inpatients from three other hospitals. Major adverse outcomes were admission to ICU, need for mechanical ventilation, progression to severe sepsis, or treatment failure. Mean hospital length of stay (LOS) was also evaluated. The rules were compared based on sensitivity, specificity, and area under the curve (AUC) of the receiver operating characteristic.


RESULTS
The rate of all adverse outcomes and hospital LOS increased directly with increasing SCAP, PSI, or CURB-65 scores (p < 0.001) in both cohorts. Patients classified as high risk by the SCAP score showed higher rates of adverse outcomes (ICU admission, 35.8%; mechanical ventilation, 16.4%; severe sepsis, 98.5%; treatment failure, 22.4%) than PSI and CURB-65 high-risk classes. The discriminatory power of SCAP, as measured by AUC, was 0.75 for ICU admission, 0.76 for mechanical ventilation, 0.79 for severe sepsis, and 0.61 for treatment failure in the external validation cohort. AUC differences with PSI or CURB-65 were found.


CONCLUSIONS
The SCAP score is as accurate or better than other current scoring systems in predicting adverse outcomes in patients hospitalized with CAP while helping classify patients into different categories of increasing risk for potentially closer monitoring.
Yandiola
Pedro Pablo España
PPE
Service of Pneumology, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain. Electronic address: pedropablo.espanayandiola@osakidetza.net.
Capelastegui
Alberto
A
Service of Pneumology, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain.
Quintana
José
J
Research Unit, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain.
Diez
Rosa
R
Service of Pneumology, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain.
Gorordo
Inmaculada
I
Service of Pneumology, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain.
Bilbao
Amaia
A
Basque Foundation for Health Innovation and Research, Sondika, Bizkaia, Spain.
Zalacain
Rafael
R
Cruces Hospital, Vizcaya, Spain.
Menendez
Rosario
R
Service of Pneumonology, Hospital Universitario La Fe, Valencia, Spain.
Torres
Antonio
A
Hospital Clinic Institut d'Investigacions Biomédiques August Pi i Sunyer, Universita de Barcelona, Barcelona, Spain.
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019540:Area Under Curve; D002423:Cause of Death; D015331:Cohort Studies; D003131:Combined Modality Therapy; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012121:Respiration, Artificial; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D016019:Survival Analysis
D000900:Anti-Bacterial Agents