title: Performance of SOAR (systolic blood pressure, oxygenation, age and respiratory rate) scoring criteria in community-acquired pneumonia: a prospective multi-centre study.
abstract: BACKGROUND
  severity assessment in community-acquired pneumonia (CAP) is important as it is associated with significant mortality. In this study, we compared a previously suggested severity assessment rule for CAP- SOAR (systolic blood pressure, oxygenation, age and respiratory rate)- against the CURB-65 criteria.
  
  
  METHODS
  we conducted a prospective study in three hospitals in Norfolk and Suffolk, UK. Consecutive patients with CAP were scored for severity with CURB-65 (n = 190), and SOAR (when there was sufficient information, n = 112). Mortality data was collected at 6 weeks.
  
  
  RESULTS
  there were 100 males (53%). The age range was 18-101 years (mean 72 years, median 76 years). Sixty-five (34%) had severe pneumonia by CURB-65, and 56 patients out of 112 (50%) had severe pneumonia by SOAR. Patients with severe CAP were significantly more likely to be older, female, and to have higher urea levels and a lower PaO(2):FiO(2) ratio on admission. There were a total of 54 deaths during follow-up (33 of these in the SOAR-categorised group). There were 32 deaths (50%) in the severe and 22 deaths (18%) in the non-severe groups by CURB-65. There were 23 deaths (70%) in the severe and 22 deaths (30%) in the non-severe groups by SOAR. For CURB-65, sensitivity, specificity, positive and negative predictive values were 60.6, 72.2, 47.6 and 81.4%. For SOAR, the respective values were 69.7%, 58.2, 41.1 and 82.1%.
  
  
  CONCLUSIONS
  SOAR had demonstrably better sensitivity, but lower specificity compared with CURB-65 in this patient cohort. SOAR might be more suitable for assessing disease severity as an alternative or adjunct to CURB-65, particularly in the elderly.
authors.affiliation: Department of Clinical Genetics, Addenbrooke's Hospital, Cambridge, UK. deepsubs@gmail.com
authors.forename: Deepak N
authors.initials: DN
authors.lastname: Subramanian
authors.forename: Patrick
authors.initials: P
authors.lastname: Musonda
authors.forename: Prasanna
authors.initials: P
authors.lastname: Sankaran
authors.forename: Syed M
authors.initials: SM
authors.lastname: Tariq
authors.forename: Ajay V
authors.initials: AV
authors.lastname: Kamath
authors.forename: Phyo Kyaw
authors.initials: PK
authors.lastname: Myint
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017714:Community-Acquired Infections / Q000145:classification / Q000401:mortality / Q000503:physiopathology; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000145:classification* / Q000401:mortality / Q000503:physiopathology; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index