Prediction model for mortality in cancer patients with pneumonia: comparison with CURB-65 and PSI.
OBJECTIVE
We aimed to develop a new prediction model of mortality in cancer patients with pneumonia and to compare its performance with CURB-65 and the Pneumonia Severity Index (PSI).


METHODS
Active cancer patients who were diagnosed with pneumonia at the Emergency Department (ED) from 7/1/2014 to 12/31/2014 were consecutively included. Clinical data were collected through a medical chart review. The primary outcome was the 28-day mortality, and clinical factors were analyzed using logistic regression analysis.


RESULTS
Among a total of 218 analyzed patients with a median age of 64.0 years (IQR, 56.8-71.0) and a male proportion of 72%, 42 (19.3%) died within 28 days of ED admission. By multivariate logistic regression analysis, an ECOG performance status (PS) 3 (OR: 8.54, 95% CI: 3.42-21.33) or 4 (OR: 13.17, 95% CI: 3.19-54.32), SpO2<90% (OR: 3.06, 95% CI: 1.17-8.00), and elevated lactic acid levels (OR: 1.42, 95% CI: 1.12-1.81) were significantly associated with mortality. With these three variables, a new prediction model with total scores ranged from 0 to 6 was generated. The area under the curve of the new prediction model was 0.840, compared with 0.673 and 0.586 for CURB-65 and PSI, respectively.


CONCLUSIONS
In cancer patients with pneumonia, a poor ECOG PS, SpO2<90%, and lactic acid elevation are independent predictors of mortality. The new prediction model, comprising three predictors, performs better in predicting mortality in cancer patients than CURB-65 or PSI.
Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Byung Ki
BK
Ahn
Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Yoon-Seon
YS
Lee
Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Youn-Jung
YJ
Kim
Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Chang Hwan
CH
Sohn
Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Shin
S
Ahn
Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Dong Woo
DW
Seo
Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Won Young
WY
Kim
Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Jae Ho
JH
Lee
Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Kyung Soo
KS
Lim
D000368:Aged; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D019344:Lactic Acid / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000401:mortality* / Q000473:pathology; D010100:Oxygen / Q000032:analysis*; D011014:Pneumonia / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality* / Q000473:pathology; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis
D019344:Lactic Acid; D010100:Oxygen
cancer; mortality; pneumonia; prediction